For years we have been nagged into getting screened for colon cancer, screened for breast cancer, screened for prostate cancer, screened, screened, screened. It made sense. Catch cancer early, and your chances of survival dramatically improve.
Funny, how things change–or perhaps better stated, how what the “experts” tell us may be influenced by the prevailing political winds among the intelligentsia and elites–loyally touted by the on-board media. Today, the big deal is cost cutting. And so what do the new studies suddenly tell us? We have a problem with “over diagnosis.” From the story–and get this title–”What Could Cancer Screening Hurt? A Lot Actually:”
Though screening certainly saves lives, recent studies make it clear that it also leads to biopsies, surgeries, chemotherapy and radiation — even some deaths — that otherwise would not have occurred.
Notice how the “saves lives” part is mentioned in such an understated fashion. When the Establishment’s desired message was for us all to get screened, the media stories were all about LIVES SAVED!!! Now, because the message is to lower our expectations about the level of care we can receive under universal coverage, that part is quickly rushed by, so the focus can be on FALSE POSITIVES–and somehow we’re the idiots for having believed their salesmanship in the first place:
The message that we’re over-screening for cancer isn’t necessarily a welcome one to the American public either. A whopping 87% of U.S. adults believe that routine screening is “almost always a good idea,” and 74% believe early detection saves lives “most or all of the time,” according to a 2004 survey in the Journal of the American Medical Assn. Most said they’d continue to get their screening tests even if their doctors advised against it…Part of the outcry stems from the fact that so many people know someone who was diagnosed with breast cancer in her 40s and appeared to respond to early treatment.
“Appeared” to respond to early treatment? Most cancer patients DO respond to early treatment.
Also complicating matters is that it’s easy to identify cancer survivors whose tumors were caught by screening, but it’s nearly impossible to put a face on the woman or man who is hurt by over-screening.
But what is the nature of “hurt” caused by over-screening?
But finding cancers that respond to early treatment is only one of the potential outcomes from a screening test. Many tests produce false positives, prompting additional tests that can be invasive, expensive, time-consuming and anxiety-inducing. A study published this spring in Annals of Family Medicine found that 60% of men and 49% of women had gotten at least one false positive during three years of routine screenings for ovarian, prostate, lung and colorectal cancer. As a result, 22% of those women and 29% of those men had an invasive diagnostic procedure, the study found.
So? Nobody expects these things to be perfect. But if you have to balance a serious cancer going undetected for a year or two because you weren’t screened, versus having been induced into “anxiety” or having a biopsy (an invasive procedure), or even unnecessary surgery, which would you choose?
And this is the worst of it. We could be seeing the beginnings of a meme that doctors should not treat some early cancers at all:
And some identify small cancers that grow so slowly they’d never compromise a patient’s health. Many would even go away on their own. Statisticians and epidemiologists know this for a fact. The problem is, there’s no way to tell which of the tumors are dangerous and need to be treated and which are harmless and would be best left alone. So all of them get treated, often aggressively. The medical establishment calls this overdiagnosis.
“Overdiagnosis is the hardest thing to explain to people,” said Dr. Stephen Taplin, chief of the Applied Cancer Screening Research Branch at the National Cancer Institute in Washington, D.C. “No individual woman can know if they’re overdiagnosed. They know they have cancer, and they’re scared to death. It’s completely justified. But if you look at people overall,” he added, “there are some people who suffered that scare unnecessarily. If they had never known about that cancer, it wouldn’t have affected their life.”
As someone whose father died because the doctors at the Veteran’s Administration failed to do proper screening tests even after he exhibited symptoms, I know to the marrow of my bones how cancer caught too late affects lives.
I am not against adjusting general guidelines to reflect empirical data, but this new thrust seems to be far more than that. Perhaps I am too cynical–how can one not be these days?–but it seem to me that the ground is being prepared to convince us that we are better off receiving lower levels of care.
November 22nd, 2009 | 12:44 pm
[...] This post was mentioned on Twitter by Wesley J. Smith and Orlando Chiropractor, Cancer Left. Cancer Left said: Scientific Study Whiplash: Now We Do Too Much Preventive Medical Screening http://bit.ly/6qab7p [...]
November 22nd, 2009 | 1:58 pm
You don’t seem to realize that we learn essentially nothing from the outcomes of individual cases, whether the ending be happy or unhappy, because we don’t know what would have happened if the other path had been taken. The only way we can actually measure the effectiveness of cancer screening is by comparing outcomes between screened people and people who have not been screened, and what we are seeing is that there is surprisingly little difference in life expectancy. Some lives may be saved, but others are being shortened due to surgical complications, adverse drug reactions, or simply stress. What is the point of all of that medical treatment if it doesn’t actually produce any measurable benefit?
November 22nd, 2009 | 2:11 pm
You don’t seem to understand the problem- some of the women who are overdiagnosed will receive chemotherapy and radiation therapy when they don’t need it. And those treatments have side effects.
November 22nd, 2009 | 2:12 pm
Wes, I think you’re being perfectly rational. This is a setup. As always, women will be the first to suffer most.
Robert at bioethike.com
November 22nd, 2009 | 3:40 pm
>>>but it seem to me that the ground is being prepared to convince us that we are better off receiving lower levels of care.<<<
"IT" may be so Wesley but if a doctor told me that I needed a certain test, I would probably do "IT" cause they deserve the respect and I would also hope that "IT" was done in time, God's Time that is!:)
I'll close by saying that the more which is given to us, the more that is expected of us and as you also probably believe, I like to think that doctors are doing their best but then as you say in so many words, no bodies are perfect.
Peace
November 22nd, 2009 | 3:47 pm
>>>but it seem to me that the ground is being prepared to convince us that we are better off receiving lower levels of care.<<<
"IT" may be so Wesley but if a doctor told me that I needed or didn't need a certain test, I would probably accept "IT" cause they deserve the respect and I would also hope that if needed, "IT" was done in time, God's Time that is!:)
I'll close by saying that the more which is given to us, the more that is expected of us and as you also probably believe, I like to think that doctors are doing their best but then as you also try to say in so many words, no bodies are perfect.
Peace
November 22nd, 2009 | 4:30 pm
But that’s no reason not to screen. Moreover, the story says they don’t know which tumors will resolve spontaneously and which not. So which side do you think we should error on? I say over diagnosis, not under diagnosis.
November 22nd, 2009 | 4:31 pm
What are you talking about JLA. OF COURSE there is measurable benefit in saved lives. Good grief.
November 22nd, 2009 | 4:50 pm
The brouhaha over the new cancer screening recommendations show how a right conclusion sometimes emerges from a wrong understanding. The right conclusion is this: Whenever government is involved in financing health care, political considerations are impossible to avoid. Evidence for this is the large number of elected officials who have weighed in on this matter, whether for or against implementation of the recommendations. This insight is, frankly, more important than the details of the recommendations themselves.
Somewhat reluctantly, because it may distract from the point made above, I’ll address at least one of the recommendations themselves. The new recommendations are not without merit. In fact, they are the same recommendations I have been giving my patients for several years. (I am a medical oncologist.) As one example, the government panel concluded that “the evidence is insufficient to recommend for or against teaching or performing routine breast self-examination (BSE).” The most important study underlying that recommendation enrolled over a quarter of a million women. Half were instructed and encouraged to do breast self-examination; half were not. The overall death rate and the death rate due to breast cancer was identical in the two groups. The only outcome that differed between the two was that the BSE group had many more breast biopsies which proved to be benign. The number of breast biopsies which proved to be malignant was equal.
Of course, none of these recommendations applies to people who already have symptoms suggestive of cancer, as you describe concerning your late father. By definition, investigation of such symptoms is not screening.
As techniques of cancer screening change, or as populations at different levels of risk are identified, the recommendations for cancer screening may change. That’s the way it is in science. But the heavy hand of politics in government-financed health care will not change–except to get worse.
November 22nd, 2009 | 5:48 pm
Indeed, Eric: In fact, what concerned me so much about this story is not that suggested guidelines might change, but that it is being pushed hard on the PR front. And the message–at least of the LA Times piece I quoted and linked–is that screening can HURT you A LOT. Good grief.
November 22nd, 2009 | 8:12 pm
This article is just stupid. When it’s time for me to get regular breast cancer screenings, I’m getting them, false scares or not. I’d rather be occasionally scared but later alive due to cancer screening than never scared and later dead due to lack thereof. In terms of fear, moreover, we may as well not read the newspaper, watch the news, pursue something we care about, or even leave our homes if our purpose is to avoid “induced anxiety.”
November 23rd, 2009 | 2:44 pm
Interesting that this appears at this time, as you say, Wesley. Doctors will tell you, and studies have confirmed, that women see doctors and go through medical procedures on average far more than men do, so more health care dollars are spent on them…
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