Thursday, October 22, 2009

Cancer: To Screen Or Not To Screen

The New York Times on Monday published:
Cancer Society, in Shift, Has Concerns on Screenings

Dr. Otis Brawley, chief medical officer of the American Cancer Society:
"I’m admitting that American medicine has overpromised when it comes to screening. The advantages to screening have been exaggerated."
It's not just that screening may be a nuisance, a costly nuisance, there's admission it may be harmful:
[Screenings find] cancers that do not need to be found because they would never spread and kill or even be noticed if left alone. That has led to a huge increase in cancer diagnoses because, without screening, those innocuous cancers would go undetected.

The very idea that some cancers are not dangerous and some might actually go away on their own can be hard to swallow, researchers say.

Screening has the problem called overdiagnosis - labeling innocuous tumors cancer and treating them as though they could be lethal when in fact they are not dangerous.

"Overdiagnosis is pure, unadulterated harm," [said Dr. Kramer, associate director for disease prevention at the NIH.]
Cancer goes away. All by itself. You can't beat that. We should be putting all this screening money into finding out what makes cancer "go away," and which tumors are actionable.


Anonymous said...

[Screenings find] cancers that do not need to be found because they would never spread and kill or even be noticed if left alone. That has led to a huge increase in cancer diagnoses because, without screening, those innocuous cancers would go undetected.

I understand the doctor's perspective, but for myself couldn't disagree more. I'd opt for the most sensitive scan possible. If there's innocuous cancer in my body, lets document and track it like we do orbiting space junk. Best to know the potential hazzards. I prefer the false positive over the false sense of security of a lesser scan. Is that so wrong?

Bix said...

I think we spent a lot of money and research on detection, which in and of itself is not bad. Certainly it generates profits. However, we didn't spend proportionate money on treatments, including knowing when not to treat. This is especially the case for prostate cancer.

And we are sorely lacking in money spent on researching determinates of health, and on transforming that knowledge into action. Let's not get cancer in the first place.

Determinates of health - these are social, political, economic, environmental forces that impact quality of life. Things like good food, clean water, security (freedom from violence), tolerance, sound infrastructure, universal education, freedom to pursue personal or corporate industry. To me, these are determinates of health. I believe that universal basic health care should be included in this list.

Ruby said...

I've been reading these articles with great interest because I have a health issue right now that's in this gray area. I'm dealing with a breast issue which is probably a benign condition, but there's also a remote possibility that it could be DCIS, one of these "new" cancers that we can detect now but aren't that scary. My doctor has been sort of trying not to order me an MRI because that just opens up a whole different can of worms with false positives and whatnot. Regardless, it is causing some rather unpleasant symptoms, so we're going to have to do *something*. We're sort of waiting for symptoms to get bad enough for her to operate. I was actually trying to avoid doing yearly mammograms until this popped up (not detected on a mammogram, by the way), but now I'm in the high risk group, which means they want to zap every year.

Bix said...

Oh Jeez, Ruby. It's hard, this news. I'm really sorry to hear it. Lots of anxiety.

I'm sure you've read everything you can get your hands on too. I ran across this quick piece today:

That mentioned taking time before making decisions. That many are slow-growing. Although it sounds like you may be experiencing some discomfort. I hear you about having to have a relationship with the mammogram team.

Anything I run across I'll post.

Anonymous said...

Hi Ruby, maybe you should read this book and check out some of these doctors.

Book by Suzzane Somers
Knockout: Interviews with Doctors Who Are Curing Cancer--And How to Prevent Getting It in the First Place (Hardcover)

Just a thought, Kathy

Anonymous said...

Be extremely careful exloring beyond the realm of evidence based medicine. Self deception is common; scientific rigor helps avoid that. It's still very much the wild wild west out there so don't stray to far from the light.

Bix said...

Thought you said that well, Anon. There are some loopy therapies out there.

Ruby said...

I'm not really all that worried. I have a GREAT doctor and she's monitoring me. It's just a small (like 5%) chance that it's cancer, and even if it is, it's considered to be more of a pre-cancer or stage 0. So.. thanks everyone, but I'm not losing any sleep over it. :-) These articles that have been coming out lately are just interesting to me, because DCIS is one of those "new" cancers that we primarily know about because of early detection. (Sometimes it can show up on mammograms as calcifications - whatever I have hasn't appeared on any mammograms, though.)

Thanks for the article, Bix!