Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Patients and physicians should screen for cancer, but cautiously

George Lundberg, MD
Conditions
October 6, 2010
137 Shares
Share
Tweet
Share

To screen or not to screen? That is not the question.

The question is not whether to screen, it is why, what, where, when, how, and how much, how often, and at what cost for what benefit.

Patients and physicians must and do screen. The issue is cautious appropriateness. Self-screening by patients is easy, free, and fundamentally harmless. Look at your skin for potential melanomas, be alert to warning symptoms of a stroke, learn the early signs of alcohol dependence, observe your urine for gross blood.

These are observations that have almost no downsides and could trigger life saving interventions. But when the American Medical Marketing Machine (AMMM) starts screening campaigns, watch out. Both the well intended zeal of the advocacy groups and the ambitious avarice of the suppliers and providers can wreak real havoc, especially when they combine forces.

Is the benefit to individuals or the public going to be worth the harm to individuals and the costs to whomsoever pays the bills? Case in point: lung cancer.

The number one cancer killer in America. A really big deal. Caught late; usually kills; caught early; also often kills. How could even earlier change that equation? What are the downsides to screening for it?

Five investigators at the National Cancer Institute in 2010 reported in the Annals of Internal Medicine the results of a randomized, controlled clinical trial using low dose computed tomography (CT) versus chest x-ray on more than 3,000 current or past 30 pack-year smokers ages 55 to 74 with no history of lung cancer.

The cumulative risk outcome of a false-positive after one annual screen with CT was 21% and after two, 33%; false positive rates after chest x-ray were 9% and 15% at one and two years.

Not trivial results, and they often triggered an unnecessary and potentially hazardous invasive procedure, not to mention the hazard of the radiation itself.

Good things can happen after screening. But so can bad. A false positive means you found something that was not there; a false negative means something was there and you did not find it; a misidentification means you found something that was there but you called it the wrong thing.

Those are all bad. It is a little like in football; you throw a forward pass; three things can happen, but two of them are bad.

So, sure, screen; but remember Hippocrates. First, do no harm.

George Lundberg is a MedPage Today Editor-at-Large and former editor of the Journal of the American Medical Association.

Originally published in MedPage Today. Visit MedPageToday.com for more lung cancer news.

Prev

Catherine Zeta-Jones blames doctors for Michael Douglas' throat cancer

October 6, 2010 Kevin 42
…
Next

10 good things that can happen from cancer

October 6, 2010 Kevin 5
…

Tagged as: Oncology/Hematology, Patients, Primary Care

Post navigation

< Previous Post
Catherine Zeta-Jones blames doctors for Michael Douglas' throat cancer
Next Post >
10 good things that can happen from cancer

More by George Lundberg, MD

  • a desk with keyboard and ipad with the kevinmd logo

    Pathologists face a stark career choice

    George Lundberg, MD
  • a desk with keyboard and ipad with the kevinmd logo

    A culture of cover-up has slowed the patient safety movement

    George Lundberg, MD
  • a desk with keyboard and ipad with the kevinmd logo

    Do drugs aid and abet genius or does genius lead to drugs?

    George Lundberg, MD

More in Conditions

  • A complex patient interviews a retired physician

    Ann McColl and James Whitlock, MD
  • Burnout on the U.S.S. Enterprise

    Arthur Lazarus, MD, MBA
  • The toll of health care: suicide risk among professionals

    Michele Luckenbaugh
  • Embracing life’s purpose in the face of inevitable death

    Michael Brant-Zawadzki, MD
  • From ICU to kidney mass: a nurse’s journey of fear

    Debbie Moore-Black, RN
  • Intravenous immunoglobulin for gastroparesis: What happened to me

    Maria Jay
  • Most Popular

  • Past Week

    • Health care’s hidden problem: hospital primary care losses

      Christopher Habig, MBA | Policy
    • The dark role of science, medicine, and tasers

      L. Joseph Parker, MD | Physician
    • From fishing licenses to gun control

      Mitch Bruss, MD | Policy
    • 3 key things to do before year end to reduce taxes

      Amarish Dave, DO | Finance
    • Tips for success as a plastic surgeon [PODCAST]

      The Podcast by KevinMD | Podcast
    • Physicians turn feelings of frustration and powerlessness into purpose and hope

      Kim Downey, PT | Physician
  • Past 6 Months

    • Medicare coverage saves lives. Enrolling shouldn’t be this complicated.

      Catherine L. Chen, MD, MPH | Physician
    • The erosion of compassion in medicine

      Daniel Luger, MD | Education
    • Emergency department burnout: a cry for change

      Anonymous | Conditions
    • Health care’s hidden problem: hospital primary care losses

      Christopher Habig, MBA | Policy
    • Pain medicine realities: beyond the opioid crisis

      Richard A. Lawhern, PhD and Stephen E. Nadeau, MD | Conditions
    • When medical protocol meets family concerns

      Richard Young, MD | Conditions
  • Recent Posts

    • Tips for success as a plastic surgeon [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why write? Physicians share their stories of healing through writing.

      Kim Downey, PT | Physician
    • A complex patient interviews a retired physician

      Ann McColl and James Whitlock, MD | Conditions
    • Navigating life’s crossroads: Change, accept, or leave [PODCAST]

      The Podcast by KevinMD | Podcast
    • A doctor struggles to provide mental health care in Appalachia

      Ryan McCarthy, MD | Physician
    • Burnout on the U.S.S. Enterprise

      Arthur Lazarus, MD, MBA | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 6 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Less-Frequent Surveillance Mammo Feasible in Older Breast Cancer Survivors
  • AI and Breast Cancer Screening; Cancer After Treatment for Sickle Cell
  • Yes, Conversion Therapy Efforts Still Exist in Medical Practice
  • Bilateral Mastectomy Not Tied to Better Survival in BRCA1-Positive Breast Cancer
  • FDA Inspections of Foreign Drug Manufacturers Haven't Bounced Back After Pandemic

Meeting Coverage

  • Less-Frequent Surveillance Mammo Feasible in Older Breast Cancer Survivors
  • Bilateral Mastectomy Not Tied to Better Survival in BRCA1-Positive Breast Cancer
  • Is Omitting Radiation Therapy in Low-Risk Breast Cancer a Good IDEA?
  • Study Supports ADC as a New Option for Endocrine-Resistant Metastatic Breast Cancer
  • Maintenance Pembrolizumab-Olaparib Fails to Boost Survival in TNBC
  • Most Popular

  • Past Week

    • Health care’s hidden problem: hospital primary care losses

      Christopher Habig, MBA | Policy
    • The dark role of science, medicine, and tasers

      L. Joseph Parker, MD | Physician
    • From fishing licenses to gun control

      Mitch Bruss, MD | Policy
    • 3 key things to do before year end to reduce taxes

      Amarish Dave, DO | Finance
    • Tips for success as a plastic surgeon [PODCAST]

      The Podcast by KevinMD | Podcast
    • Physicians turn feelings of frustration and powerlessness into purpose and hope

      Kim Downey, PT | Physician
  • Past 6 Months

    • Medicare coverage saves lives. Enrolling shouldn’t be this complicated.

      Catherine L. Chen, MD, MPH | Physician
    • The erosion of compassion in medicine

      Daniel Luger, MD | Education
    • Emergency department burnout: a cry for change

      Anonymous | Conditions
    • Health care’s hidden problem: hospital primary care losses

      Christopher Habig, MBA | Policy
    • Pain medicine realities: beyond the opioid crisis

      Richard A. Lawhern, PhD and Stephen E. Nadeau, MD | Conditions
    • When medical protocol meets family concerns

      Richard Young, MD | Conditions
  • Recent Posts

    • Tips for success as a plastic surgeon [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why write? Physicians share their stories of healing through writing.

      Kim Downey, PT | Physician
    • A complex patient interviews a retired physician

      Ann McColl and James Whitlock, MD | Conditions
    • Navigating life’s crossroads: Change, accept, or leave [PODCAST]

      The Podcast by KevinMD | Podcast
    • A doctor struggles to provide mental health care in Appalachia

      Ryan McCarthy, MD | Physician
    • Burnout on the U.S.S. Enterprise

      Arthur Lazarus, MD, MBA | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Patients and physicians should screen for cancer, but cautiously
6 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...