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

Many doctors fail to understand the math of cancer prevention

Peter Ubel, MD
Physician
August 2, 2012
316 Shares
Share
Tweet
Share

All too often the most powerful illusions seduce us through truthful whisperings.  Let’s start with an obvious truth: Living a long and happy life after a cancer diagnosis is better than living a short miserable one.

Given a choice between receiving a diagnosis of metastatic cancer—an incurable life-ending-it’s-already-spread-to-your-brain neoplasm—versus the diagnosis of a localized, snip-it-out-and-it’s-done tumor: Who wouldn’t choose the latter?

And yet this simple truth causes doctors to embrace unproven screening tests, the result being millions of dollars of potentially wasteful medical care and an untold amount of unnecessary anxiety.

In a recent study published in the Annals of Internal Medicine, researchers surveyed primary care physicians and asked them a series of questions designed to determine what makes physicians embrace cancer screening tests.  In one portion of the survey, the researchers describe the hypothetical screening test as follows: “Screen detected cancers have better five year survival rates than cancers detected because of symptoms,” and then asked doctors whether this fact proved that the screening test “saves lives.”  A whopping 76% of physicians mistakenly concluded that the test was lifesaving.

I have written a couple recent posts about the prostate cancer screening controversy.  In these posts, I explain why the PSA test is so appealing—it catches cancers so early that they can be removed in their entirety; it means prostate cancer doctors can treat early illness rather than metastatic disease.

But when a screening test finds a tiny cancer—a tumor that on its own would have dozed indolently inside a person’s body without ever causing harm—that person has been harmed by the test, not helped.  That person will now undergo a painful and unnecessary treatment, living the rest of his life as a cancer “survivor” worried that the tumor will recur.

The only good thing about finding this early cancer is that this person has a great chance of surviving more than five years without dying from this cancer.  Of course, he would have survived five years without dying from the cancer anyway.  Five year survival statistics are not an appropriate way of determining whether a screening test works.

How strong is the illusion among doctors that five year survival rates are a good measure of whether a screening test is effective?  In one portion of their survey, the researchers described a screening test that increased five year survival rates.  Almost 70% of doctors said they would recommend that test to their patients, even though this five year statistic may simply reflect the identification of indolent, harmless cancers!

Worse yet, in another portion of their survey, the researchers presented doctors with information on a screening test that reduced the number of people dying from the cancer in question.  They explained that people who didn’t receive the test were more likely to die of the cancer than people who did.  This type of mortality reduction is the gold standard for determining whether a screening test does what it’s supposed to do—namely, identify an otherwise life-threatening illness while it is still curable and thereby save lives.  And yet, only 20% of doctors said they would definitely recommend this test to their patients.  I guess they were unimpressed, because they hadn’t learned whether the screening test was associated with higher five year survival rates!

Seduced by a simple but misleading truth, most physicians embrace cancer screening tests without comprehending what makes such tests harmful or beneficial.  When it comes to understanding the math of cancer prevention, too many physicians are no smarter than fifth graders.

Peter Ubel is a physician and behavioral scientist who blogs at his self-titled site, Peter Ubel and can be reached on Twitter @PeterUbel.  He is the author of Critical Decisions: How You and Your Doctor Can Make the Right Medical Choices Together.

Prev

My dream of universal acceptance of EHR has turned sour

August 2, 2012 Kevin 33
…
Next

Well meaning improvements can hurt critical healing relationships

August 3, 2012 Kevin 0
…

Tagged as: Oncology/Hematology

Post navigation

< Previous Post
My dream of universal acceptance of EHR has turned sour
Next Post >
Well meaning improvements can hurt critical healing relationships

More by Peter Ubel, MD

  • Clinicians shouldn’t be punished for taking care of needy populations

    Peter Ubel, MD
  • Patients alone cannot combat high health care prices

    Peter Ubel, MD
  • Is the FDA too slow to handle the pandemic?

    Peter Ubel, MD

More in Physician

  • The patient who became my soulmate

    Anonymous
  • Breaking the stigma: Addressing the struggles of physicians

    Jean Antonucci, MD
  • Life as a physician is sometimes like a runaway trailer

    Christopher Nyte, DO
  • The controversial origin of the Hippocratic oath

    Brian Elliott, MD
  • From physician to patient: one doctor’s journey to finding purpose after a devastating injury

    Stephanie Pearson, MD
  • Navigating life’s zero-sum game: the struggles of competitive health care professionals

    Deepak Gupta, MD
  • Most Popular

  • Past Week

    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
    • Unintended consequences of Health Care Quality Improvement Act: a violation of physicians’ civil and constitutional rights

      Farid Gharagozloo, MD & Rainer Gruessner, MD & Robert Poston, MD | Physician
    • From physician to patient: one doctor’s journey to finding purpose after a devastating injury

      Stephanie Pearson, MD | Physician
    • An unspoken truth about non-compete clauses in medicine

      Harry Severance, MD | Policy
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • Fostering the next (diverse) generation of clinicians

      Imamu Tomlinson, MD, MBA | Physician
  • Past 6 Months

    • The hidden dangers of the Nebraska Heartbeat Act

      Meghan Sheehan, MD | Policy
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
    • Why are doctors sued and politicians aren’t?

      Kellie Lease Stecher, MD | Physician
    • The Titanic sinking: a metaphor for the impending collapse of medicine

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD & Shreekant Vasudhev, MD | Physician
  • Recent Posts

    • Redefining success: a journey of self-discovery and fulfillment [PODCAST]

      The Podcast by KevinMD | Podcast
    • Yoga and self-care won’t cure my Crohn’s disease

      Kristen L. Cole | Conditions
    • The patient who became my soulmate

      Anonymous | Physician
    • Breaking the stigma: Addressing the struggles of physicians

      Jean Antonucci, MD | Physician
    • Can AI solve the physician shortage crisis?

      Harry Severance, MD | Tech
    • Breaking barriers in arthritis care with telemedicine [PODCAST]

      The Podcast by KevinMD | Podcast

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 3 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

  • Another Win for a JAK Inhibitor in Alopecia Areata
  • 'It Is a Horrifying Prospect': What We Heard This Week
  • Temp Nurses Cost Hospitals Big During Pandemic. Lawmakers Are Now Mulling Limits.
  • Biologic Switch Revs Up Response in Plaque Psoriasis
  • Man Versus Malaria

Meeting Coverage

  • Another Win for a JAK Inhibitor in Alopecia Areata
  • Biologic Switch Revs Up Response in Plaque Psoriasis
  • Adding Pembrolizumab to Docetaxel Fails to Improve Survival in mCRPC
  • Moving Newer Agents Up Earlier in Advanced Bladder Cancer
  • Latest on Neoadjuvant Immunotherapy in Muscle-Invasive Bladder Cancer
  • Most Popular

  • Past Week

    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
    • Unintended consequences of Health Care Quality Improvement Act: a violation of physicians’ civil and constitutional rights

      Farid Gharagozloo, MD & Rainer Gruessner, MD & Robert Poston, MD | Physician
    • From physician to patient: one doctor’s journey to finding purpose after a devastating injury

      Stephanie Pearson, MD | Physician
    • An unspoken truth about non-compete clauses in medicine

      Harry Severance, MD | Policy
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • Fostering the next (diverse) generation of clinicians

      Imamu Tomlinson, MD, MBA | Physician
  • Past 6 Months

    • The hidden dangers of the Nebraska Heartbeat Act

      Meghan Sheehan, MD | Policy
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
    • Why are doctors sued and politicians aren’t?

      Kellie Lease Stecher, MD | Physician
    • The Titanic sinking: a metaphor for the impending collapse of medicine

      Aaron Morgenstein, MD & Corinne Sundar Rao, MD & Shreekant Vasudhev, MD | Physician
  • Recent Posts

    • Redefining success: a journey of self-discovery and fulfillment [PODCAST]

      The Podcast by KevinMD | Podcast
    • Yoga and self-care won’t cure my Crohn’s disease

      Kristen L. Cole | Conditions
    • The patient who became my soulmate

      Anonymous | Physician
    • Breaking the stigma: Addressing the struggles of physicians

      Jean Antonucci, MD | Physician
    • Can AI solve the physician shortage crisis?

      Harry Severance, MD | Tech
    • Breaking barriers in arthritis care with telemedicine [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

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

Many doctors fail to understand the math of cancer prevention
3 comments

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

Loading Comments...