In recent years, light has been shed on the harms of cancer screening, but many doctors still claim that it “saves lives.” Are we being told the whole truth?
“Why cancer screening has never been shown to ‘save lives’—and what we can do about it” published by British Medical Journal questions whether or not disease-specific death is the same as overall survivability. Prasad argues that the real benchmark for the success of any cancer screening program is if the “early stage” cancers being diagnosed and treated actually result in an increase in overall survivability. Disease-specific reductions in death is not the same as overall length and quality of life. It’s a mere belief doctors sell to us that lowering death rates from cancer means people live longer.
“Using disease specific mortality as a proxy for overall mortality deprives people of information about their chief concern: reducing their risk of dying. Although some people may have personal reasons for wanting to avoid a specific diagnosis, the burden falls on providers to provide clear information about both disease specific and overall mortality and to ensure that the overall goal of healthcare—to improve quantity and quality of life—is not undermined. In this article we argue that overall mortality should be the benchmark against which screening is judged and discuss how to improve the evidence upon which screening rests.”
This means that without proper benchmarking all of the fundraising efforts going towards cancer research of any kind (all of the [insert body part] cancer walks and runs and bike rides fundraisers) become misleading.
The Problem: Physical and Psychological Trauma
With high levels of screening, more tumors are diagnosed – but breast cancer death rates are no lower than in areas with fewer screenings, researchers report. This is what Prasad is trying to show in his article. He claims that healthy people care about living longer, and their doctors convince them that getting screened will help them in the long term. Oftentimes these screenings show false positives that result in physical and psychological traumas to the patient. Overdiagnosis, false positives, and fear mongering can result in unnecessary removal of certain organs for “preventative measures.”
“Although some people may have personal reasons for wanting to avoid a specific diagnosis, the burden falls on providers to provide clear information about both disease specific and overall mortality and to ensure that the overall goal of healthcare—to improve quantity and quality of life—is not undermined.”
“For example, prostate specific antigen (PSA) testing yields numerous false positive results, which contribute to over one million prostate biopsies a year.12 Prostate biopsies are associated with serious harms, including admission to hospital and death. Moreover, men diagnosed with prostate cancer are more likely to have a heart attack or commit suicide in the year after diagnosis or to die of complications of treatment for cancers that may never have caused symptoms.”
It’s been proven that PSA screening is useful for high-risk populations and people, but the common result is significant increases in anxiety due to false positive PSA results. With the false positive rates of up to 75% (sometimes higher), it’s clear that this test is very nonspecific and sometimes harmful to the healthy person being tested.
The public has this wildly inflated sense of benefits and discounted sense of harms of mammography screening, cervical smear tests, and PSA screening. Prasad found one study that showed 68% of women thought that mammography would lower their risk of getting breast cancer, 62% thought that screening at least halved the rate of breast cancer, and 75% thought that 10 years of screening would prevent 10 breast cancer deaths per 1000 women. He claims that the most optimistic estimates of screening did not even come close to those numbers. The review of randomised controlled trials of PSA screening failed to show lowered disease specific death. The same was found in randomized mammography trials.
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The Solution: Take Recommendations with a Grain of Salt
This blind trust the public has in screening programs keeps hidden the significant harm screening causes. The public then loses sight of the big questions. People check off for health maintenance by getting checked, but don’t discuss the pros and cons of this decision to get tested with their doctor.
The public has had more faith in screening than they should, and screening gives less insight than doctors believe and researchers show. Doctors are not being honest with their patients about the risks and benefits of doing regular screening, and this lack of honesty results in you making uninformed decisions to screen for cancers.
Prasad encourages healthcare providers to be honest about the limitations and risks of screenings. The harms of screening are certain but the overall mortality are not. He suggests that declining screening may be a reasonable choice for many people. Prasad calls for, as we should all call for, higher standards of evidence that enables rationale and shared decision making between doctors and patients.
Always remember that prevention is key. Remember that your health starts with what you put in your body. Here are a few links to useful foods to help prevent getting certain cancers, and how to do self-screening:
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