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Re-evaluating the Benefits of Cancer Screening
uncleO writes "An article in the NY Times describes two studies that weigh the harm caused by cancer screenings against the benefits they provide. From the article, 'Two recent clinical trials of prostate cancer screening cast doubt on whether many lives — or any — are saved. And it said that screening often leads to what can be disabling treatments for men whose cancer otherwise would never have harmed them. A new analysis of mammography concluded that while mammograms find cancer in 138,000 women each year, as many as 120,000 to 134,000 of those women either have cancers that are already lethal or have cancers that grow so slowly they do not need to be treated. ... 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."
Seems like someone is driving a huge PR campaign for "let's not have people visit doctors and get cancer screening". It's likely actually just costing a group of HMO insurers more money to have lots of people treat cancers early and undergo lengthy treatment, and then survive, rather than have a smaller number of people detect it too late, do a short treatment, and then just die.
After all, health services are a business. We understand. You can't just have insured people liviing a long time and making businesses lose money.
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The thing is that cancer is not one disorder, or even just a few disorders. Heart disease can reasonably be considered one disorder (although it is probably more accurately viewed as three or four disorders). There are hundreds of different disorders that we lump together under the term cancer.
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Presumably for the reasons enumerated in the summary. Too many costly, and quite frankly terrifying, false positives. Keep in mind, when you start talk about putting everyone through a screening, whether it be for cancer or HIV or terrorism, your screen had better be crazily accurate. Imagine there's a (really exceptionally good) false positive rate of 0.1% on your hypothetical test, if you give it to every person in the US twice a year you're going to produce 74,000 false positives a year. Or to put it another way, more false negatives than there are cancer deaths.
as many as 120,000 to 134,000 of those women either have cancers that are already lethal or
There are a lot of cancers that are incurable, but can still be controlled for a while. Statements like this make it sound as though catching these cancers early and controlling them for a while is a worthless endeavor.
My wife is one year into a battle with a cancer that she has only roughly a 25% chance of surviving with treatment. Without treatment, she would have been dead a few weeks after diagnosis. She is grateful to have spent the past year alive instead of dead, and of course the children and I are also grateful. I guess the point that I'm trying to make here is that treating a cancer that will most likely be lethal still has significant value. None of us would have been very happy if some government bureaucrat had told us that since the cancer was so likely to kill her, they wouldn't bother treating.
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But what's the alternative? Just wait until someone's sick enough to warrant a cancer screening?
Or, to be more direct, the problem isn't the _testing_, it the _reaction_. The view of cancer is too binary... You either don't have cancer or you have ZOMG CANCER. It seems to me that by making a third category of 'mostly harmless' we could really do away with #3 altogether. How could we determine that? Early detection and study. Exactly what abandoning screens would make impossible.
Really, this is just about the money, in a couple directions:
First, no doctor is going to volunteer "this is cancer, but it doesn't look dangerous so we'll just monitor the situation" because God help them if that person dies.
Second, people usually spend other people's money (government, 'insurance') on the treatments, so to them it's only 'some side effects vs your life' and not also about 10% of their lifetime earnings too. Guess what they'll take? And so the people paying for these tests have come to realize that they're just a money pit: the (usually negative) test, the (potentially) unnecessary treatment, and finally just the cost of treating real cancer a year or so earlier then you would have had to without the screen for someone that may well die anyway (any they get the pleasure of a year of treatment). All this for how many people that earlier treatment would have helped? Well, that is the point of the study.
But the point is, that it's not the data that's bad, it's a system the encourages people to get knee jerk treatment.
Presumably for the reasons enumerated in the summary. Too many costly, and quite frankly terrifying, false positives.
More importantly, it's important that if you screen positive, the confirmatory tests and treatment yield a better outcome than doing nothing would have. Lots of people can point to a friend or relative for whom early detection treatment saved their life; however, if someone dies from the treatment of a cancer that would never have killed them, how will you ever know?
Cancer is dangerous, but it's important to remember that cancer treatments are dangerous as well. People can and do die from complications from surgery and chemotherapy.