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Value of Cancer Screening Programs More Closely Scrutinized

Posted Nov 09 2011 12:00am

With lab medicine as one of the major themes of Lab Soft News, I have posted a number of notes about cancer screening. Here are two relatively recent examples: When Routine Screening for Disease Has the Potential to Harm a Patient ; Multiplexed Urine Test Predicts Prostate Cancer Risk in Men with Elevated PSAs , We can anticipate that medical research will continue to improve cancer screening tests. And yet, we are now seeing articles questioning the value of this type of testing (see: Considering When It Might Be Best Not to Know About Cancer ). Below is an excerpt for a recent article:

After decades in which cancer screening was promoted as an unmitigated good, as the best...way for people to protect themselves from the ravages of a frightening disease, a pronounced shift is under way....Now expert groups are proposing less screening for prostate, breast and cervical cancer and have emphasized that screening comes with harms as well as benefits....What changed? The answer, for the most part, is that more information became available. New clinical trials were completed, as were analyses of other sorts of medical data. Researchers studied the risks and costs of screening more rigorously than ever before....Cancer experts say they cannot ignore a snowballing body of evidence over the past 10 years showing over and over that while early detection through widespread screening can help in some cases, those cases are small in number for most cancers. At the same time, the studies are more clearly defining screening’s harms....Researchers used to be afraid to even broach the subject of screening’s harms. “It was the third rail,” said [said an expert in the field]. “We were afraid to say exactly what we thought for fear of seeming too crazy.” It was easy to get financing to study the benefits of screening, he added, but a study that looked at harms was “too far out of the culture.” Not now, he said.... In recent years, researchers have found that many, if not most, cancers are indolent. They grow very slowly or stop growing altogether. Some even regress and do not need to be treated — they are harmless. 

This author of this article was able to quickly summarize why the attitude of physicians and healthcare consumers toward cancer screening is changing. First of all, researchers and the panels of experts that develop screening guidelines are now highlighting both the benefits and the potential harm of cancer screening. The harm comes in the form of the psychological damage to the recipients of false positive tests as well as the potential for unnecessary treatment which is wasteful and can itself cause harm. Moreover, screening tests may reveal a truely malignant tumor but one that behaves in a biologically benign fashion over time.

My conclusions from all of this are the following. First, physicians and patients are beginning to view some types of cancer screening with a jaundiced eye, no pun intended. Second, patients are becoming increasingly confused when some physicians recommend less screening and others proclaim the value of screening and diagnostic procedures as previously recommended. Lastly and as noted in the article before, one of the major drivers for some skepticism about cancer screening is the ready availability of information about both the costs and benefits of screening, often online. Once again, we are becoming aware of the influence of Dr. Google (see: Paging Dr. Google! We Are Waiting for a Second Opinion ; Teaching Consumers to Say "No" to Physicians' Recommendations ).
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