Do Cancer Screenings Help or Hurt Us? What Have You Heard?
Every year, the American Cancer Society (ACS) releases a series of reports. One of these reports was released recently and is causing a slow, resounding buzz in the online cancer community. After reading the NYTimes article, "Cancer Society, in Shift, Has Concerns on Screens" I began to understand why the biggest piece of news in the latest ACS report is already making waves.
The worry is that screening for breast cancer and prostate cancer and other certain cancers can come with the real risk of over-treating many small cancers while missing cancers that are deadly. What have you heard about this news?
Chief medical officer of the ACS says, "We don’t want people to panic. But I’m admitting that American medicine has overpromised when it comes to screening. The advantages to screening have been exaggerated.”
What exactly does the ACS mean by this? They believe prostate cancer screenings have not shown conclusively to prevent prostate cancer deaths. Mammograms, according to studies from the 60s and 80s, were found to reduce the rates of breast cancer by up to 20%. But, while the increase of early detection in cervical and colon cancer showed fewer cases of late-stage cancers - early detection of breast and prostate cancers has gone up, but there has been no decline in late-stage breast and prostate cancer.
The ACS wants people to receive more information about screening like understand their personal risks and benefits before deciding. Up until now, the ACS has always touted that, for example, mammograms are "one of the best things a woman can do to protect her health" which isn't really true. While mammograms can prevent some cancer deaths, it isn't a requirement for everyone.
But just because screening isn't a catch-all remedy for cancers, does not mean that screenings are useless. It's important that people who hear this ACS buzz don't misinterpret and believe that "screening does not work." The problem is really only when doctors find cancers that would never spread or kill them if they were simply left alone. The idea that early-detection is live-saving increased diagnoses because, without these screenings, these "innocuous" cancers would go undetected and harmless. In fact, many of the lethal breast cancers grow so fast they occur between mammograms. And deadly prostate cancers are the ones that have already spread at the time of screening. When screening for prostate or breast cancer, it is hard to tell which tumors need aggressive treatment and which can be left alone. The question might be "are we treating the cancers that need to be treated?"
Do you think people will want to hear that some cancers are not dangerous and can go away on their own? Do you think people will believe this after years of associating "cancer" with "death"? The difficulty with this new information is the potential backlash from those who firmly believe in the screenings, creating almost a political debate. Do you think, if people come out against breast cancer screenings they will be considered "against women?" Do you think people who speak against prostate screenings will be "against men?" Hopefully research about distinguishing innocuous tumors from dangerous ones will happen in the near future. So people will be able to access what screening can actually do for them.
The authors list four recommendations in their call to action for early detection and prevention:
1. Develop tests to distinguish between cancers that are lethal and those that are low-risk.
2. Reduce treatment for low-risk disease. Diagnosing cancers that don’t kill the patient has led to treatment that may do more harm than good.
3. Develop tools for physicians and patients to help them make informed decisions about prevention, screening, biopsy and treatment. Offer treatments individually tailored to a patient’s tumor.
4. Work to identify the people at highest risk for cancer and use proven preventive interventions.
What do you think of these suggestions?
In your other communities have you read any interesting posts, discussions, or comments on this news?
How can we, as Health Activists, keep the peace between screening advocates and screening skeptics?
I'm curious about what you think! Join the discussion on this topic here.
Join the Cancer Group on other cancer-related discussion! If you want to discuss Breast Cancer or mammograms specifically, join the Breast Cancer Group!
The worry is that screening for breast cancer and prostate cancer and other certain cancers can come with the real risk of over-treating many small cancers while missing cancers that are deadly. What have you heard about this news?
Chief medical officer of the ACS says, "We don’t want people to panic. But I’m admitting that American medicine has overpromised when it comes to screening. The advantages to screening have been exaggerated.”
What exactly does the ACS mean by this? They believe prostate cancer screenings have not shown conclusively to prevent prostate cancer deaths. Mammograms, according to studies from the 60s and 80s, were found to reduce the rates of breast cancer by up to 20%. But, while the increase of early detection in cervical and colon cancer showed fewer cases of late-stage cancers - early detection of breast and prostate cancers has gone up, but there has been no decline in late-stage breast and prostate cancer.
The ACS wants people to receive more information about screening like understand their personal risks and benefits before deciding. Up until now, the ACS has always touted that, for example, mammograms are "one of the best things a woman can do to protect her health" which isn't really true. While mammograms can prevent some cancer deaths, it isn't a requirement for everyone.
But just because screening isn't a catch-all remedy for cancers, does not mean that screenings are useless. It's important that people who hear this ACS buzz don't misinterpret and believe that "screening does not work." The problem is really only when doctors find cancers that would never spread or kill them if they were simply left alone. The idea that early-detection is live-saving increased diagnoses because, without these screenings, these "innocuous" cancers would go undetected and harmless. In fact, many of the lethal breast cancers grow so fast they occur between mammograms. And deadly prostate cancers are the ones that have already spread at the time of screening. When screening for prostate or breast cancer, it is hard to tell which tumors need aggressive treatment and which can be left alone. The question might be "are we treating the cancers that need to be treated?"
Do you think people will want to hear that some cancers are not dangerous and can go away on their own? Do you think people will believe this after years of associating "cancer" with "death"? The difficulty with this new information is the potential backlash from those who firmly believe in the screenings, creating almost a political debate. Do you think, if people come out against breast cancer screenings they will be considered "against women?" Do you think people who speak against prostate screenings will be "against men?" Hopefully research about distinguishing innocuous tumors from dangerous ones will happen in the near future. So people will be able to access what screening can actually do for them.
The authors list four recommendations in their call to action for early detection and prevention:
1. Develop tests to distinguish between cancers that are lethal and those that are low-risk.
2. Reduce treatment for low-risk disease. Diagnosing cancers that don’t kill the patient has led to treatment that may do more harm than good.
3. Develop tools for physicians and patients to help them make informed decisions about prevention, screening, biopsy and treatment. Offer treatments individually tailored to a patient’s tumor.
4. Work to identify the people at highest risk for cancer and use proven preventive interventions.
What do you think of these suggestions?
In your other communities have you read any interesting posts, discussions, or comments on this news?
How can we, as Health Activists, keep the peace between screening advocates and screening skeptics?
I'm curious about what you think! Join the discussion on this topic here.
Join the Cancer Group on other cancer-related discussion! If you want to discuss Breast Cancer or mammograms specifically, join the Breast Cancer Group!
Tags: acs, breast, cancer, cervical, colon, detection, mammogram, prostate, screenings, treatment
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Comment by Ellen S on October 23, 2009 at 2:53pm -
This is a subject near and dear to my heart.
Our family deals with these thoughts and concerns each year. It's very fresh in my mind as my FIL just passed away from aggressive prostate cancer that was not caught early despite screenings. Unfortunately, neither he nor his doctor were aware that the blood pressure medicine he was taking would alter that screen. In someone with a slower, more common type of PC it might not have made such a difference, but he wasn't that lucky. Prostate and breast cancer is rampant in the family. For us, screening isn't even really an option. Neither is education.
My personal opinion is that the problem isn't with most screening tests, the problem is what you do with the information the screen gives you. And yes, I believe that physicians should inform us of anything abnormal found in any test, no matter how tiny it may seem at the time. I blogged about this question: Scans reveal signs of possible disease - do you want to be told? The information should come drowned in education however. The old scene of doctor enters room, says "I'm sorry" and the findings, then leaves... well, it just isn't going to cut it anymore.
Education is vital. I think that is the best way to keep peace between screening advocates and skeptics. When patients are properly educated they make good decisions, both about their screening options and their treatments.
I am a screening advocate. Screens don't work 100%, but they do help to stack the deck in our favor. They give us vital information and baselines beyond a 'positive' diagnosis. Perhaps I am a bit biased:
Our family undergoes screens (cancer and otherwise) that seem to make sense to us, but we pay close attention to our health. Our rate of negative screens is small. That means the majority of screens we've taken have eventually found abnormalities that required observation or treatment, sometimes aggressive. Those screens have also helped answer obscure questions that didn't make sense before the abnormalities were found, sometimes leading to other vital information.
I think the recommendations above are fabulous. Change tho, comes slowly doesn't it?! I don't think those against screenings are 'against' either gender, but I do personally wonder about their perspective and reasoning. I wonder how many screening skeptics have received an abnormal screen result? Is it perhaps a case of lack of trust between physicians and patients?
We occasionally discuss screening tests such as MRI, CT and lumbar punctures (LP) in the WEGO Health Migraine group. These are expensive tests, and the LP is rather invasive. Yet physicians aren't comfortable diagnosing the cause for pain until they have at least been able to rule out serious issues such as tumors, cysts or cancer - which are rare. Additionally, patients who become anxious about these tests largely are those that don't understand that their doctors are ruling out a tumor vs looking for a tumor. When they understand this, their entire outlook usually changes. Of those very close to me, MRI screening of the brain has to date resulted in 3 large tumors, 2 strokes and a brain cyst.
Lets not forget that screening is useful for research purposes (especially retrospective) as well as re-defining "normal" parameters too. We've seen this happen lately in the Thyroid community:
As a result of supposedly 'normal' test results in the presence of symptoms of disease, the range of acceptable levels of hormones was changed and many more sick people were able to find treatment and become healthy once again. This was years in the making, and many people suffered before the changes to those parameters were made, but when physicians looked backward at the volume of test results and allowed themselves to think outside the box, the results were significant.
It's true- this isn't a case of cancer screening making a difference, but I can't help but think that the information could be just as useful there as well. As we look at PSA testing in our family and the changing thoughts how results might best be used in different circumstances, I think the prostate cancer physicians and communities are on the right track.
We're still learning.
Screening is vital in other communities such as Autoimmune Diseases, Diabetes Type 2 for example. It's important to remember that screening tests go far beyond just cancer. Osteoporosis is really huge right now, as is Lyme Disease, Chlamydia (see Pregnancy and Sexual Health groups.)
Do you think there is a difference between how we should handle cancer screening vs other health screenings? Why? What are your communities saying about screening tests?
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