The case against early cancer screening

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
Agreed. I did a heme-onc rotation, and in their opinion the only screenings that catch the rabbits were colonoscopies and the new lung cancer screening guidelines (as mentioned in the article). All other screenings, they said, especially mammograms and Pap smears, were basically bunk - finding turtles but not recognizing them as such, or finding the hopeless birds.
 
Good find, I'm not so up on my pap smear literature but the data for screening mammography is pretty abysmal, there's no overall mortality benefit to screening: the decrease in cancer mortality is slight but it's there, but if overall mortality isn't budging what does this mean? It indicates that we're doing at least as much harm as good, we're putting women through hell every time they have a false positive, subjecting them to incredible psychic distress and unnecessary procedures and we're not saving any lives overall - Maybe that overall mortality number isn't budging because we're pushing healthy women over the edge with unnecessary surgery and suffering.
 
Members don't see this ad :)
The fact that incidence can sky rocket without a dent in death is definitely something worth exploring. Especially since so many people are suffering though unnecessary therapies.

I really love this blog though, they have some great stuff.
 
generally not a huge fan of 538's data journalism that isn't sports- or politics-related (fields like medicine already have undergone statistical revolutions by people that are 1000x more qualified to write about it), but this is pretty good
 
  • Like
Reactions: 1 user
Screening for cervical cancer is definitely not useless. It's highly treatable if detected early (100% preventable if detected prior to malignancy) and the countries with the lowest incidence of mortality due to cervical cancer have the best screening programs in place (ex. Finland).
Yeah, but as with any sampling, it has errors. My mom was religious about her pap smear, and had a radical hysterectomy 2 years ago for a stage 1B adenocarcinoma in situ of the cervix. Totally missed this slow growing cancer. Followup shows no lymph node invasion, and no spread so far. Gives you a false sense of security.
 
generally not a huge fan of 538's data journalism that isn't sports- or politics-related (fields like medicine already have undergone statistical revolutions by people that are 1000x more qualified to write about it), but this is pretty good
True, but as someone who does the statistical work you speak of, I can tell you that the ongoing efforts still fall way short of what we need. More attention is not a bad thing on this case.
 
Agreed. I did a heme-onc rotation, and in their opinion the only screenings that catch the rabbits were colonoscopies and the new lung cancer screening guidelines (as mentioned in the article). All other screenings, they said, especially mammograms and Pap smears, were basically bunk - finding turtles but not recognizing them as such, or finding the hopeless birds.
What are these code words?
 
Agreed. I did a heme-onc rotation, and in their opinion the only screenings that catch the rabbits were colonoscopies and the new lung cancer screening guidelines (as mentioned in the article). All other screenings, they said, especially mammograms and Pap smears, were basically bunk - finding turtles but not recognizing them as such, or finding the hopeless birds.

Where's the data that cervical cancer screening is "bunk?" The incidence of cervical cancer is almost directly related to the screening rate. It's quite possibly one of the most effective screening programs there is.
 
  • Like
Reactions: 1 users
Where's the data that cervical cancer screening is "bunk?" The incidence of cervical cancer is almost directly related to the screening rate. It's quite possibly one of the most effective screening programs there is.

Isn't this exactly what the article points out doesn't really mean that much, especially if the death rate remains constant, i.e. you're just catching people that would likely have been asymptomatic and are just giving unnecessary treatment?

I guess one could argue that people live a bit longer so some of those cancers could be symptomatic, but...
 
Isn't this exactly what the article points out doesn't really mean that much, especially if the death rate remains constant, i.e. you're just catching people that would likely have been asymptomatic and are just giving unnecessary treatment?

I guess one could argue that people live a bit longer so some of those cancers could be symptomatic, but...

That might be true with some diseases but not cervical cancer. If caught early enough (which it generally is, anecdote above notwithstanding) it can generally be completely cured. Cervical cancer is not an example of what you're describing.

The USPSTF has a pretty good overview of their rationale for recommending cervical cancer screening. I'd suggest looking that over.
 
  • Like
Reactions: 1 users
Agreed. I did a heme-onc rotation, and in their opinion the only screenings that catch the rabbits were colonoscopies and the new lung cancer screening guidelines (as mentioned in the article). All other screenings, they said, especially mammograms and Pap smears, were basically bunk - finding turtles but not recognizing them as such, or finding the hopeless birds.
In women with confirmed HPV, Pap smears can be a life saver. I mean, there's no denying that they reduce cervical cancer death rates.
 
That might be true with some diseases but not cervical cancer. If caught early enough (which it generally is, anecdote above notwithstanding) it can generally be completely cured. Cervical cancer is not an example of what you're describing.

The USPSTF has a pretty good overview of their rationale for recommending cervical cancer screening. I'd suggest looking that over.
Avoiding harm is complicated, though. http://www.asccp.org/portals/9/docs/algorithms 7.30.13.pdf
Except for vaccination, of course!
 
Last edited by a moderator:
I understand the point that they're making and I think that we shouldn't doing screening mammograms or psas but there's definitely a benefit to screening for colon and cervical cancer
 
The takeaway I had from that article wasn't that we shouldn't screen, but that we need to actually study what we're screening for when we don't understand the natural history of many of these cancers.

I think this stuff highlights not only how little we know but also the need for shared decision making.
 
  • Like
Reactions: 1 users
I understand the point that they're making and I think that we shouldn't doing screening mammograms or psas but there's definitely a benefit to screening for colon and cervical cancer

I think it's healthy to question everything, especially in screening where so much is gospel that aught not be. I'd like to see a robust meta-analysis looking at the question of cervical cancer but from what I understand about it it has gone from being the gynecological malignancy with the highest mortality to the one with the lowest mortality in 1st world countries. This seems like the kind of benefit that is hard to attribute to any particular bias.

I have, however, heard some troubling assertions about colonoscopy. While it does seem to have a definite mortality benefit I've heard from one of the statistical leaders in the field (I try not to take the words of others as gospel but in this man's case I might make an exception) that sigmoidoscopy performed once at 50 has the same benefit as colonoscopy every ten years.

I think a critical appraisal by every current of future doctor is necessary, a new understanding of statistics and medicine based on the number needed to treat and number needed to harm is essential to the betterment of our craft and the safety of our patients.
 
This article is similar to a PBS documentary called 'Money & Medicine'

Here's the think: http://www.pbs.org/program/money-medicine/

Great Documentary.

Not to mention embarrassing for UCLA especially considering:

http://www.ncbi.nlm.nih.gov/pubmed/22331982

Conclusion: In a nationally representative sample, higher patient satisfaction was associated with less emergency department use but with greater inpatient use, higher overall health care and prescription drug expenditures, and increased mortality.
 
  • Like
Reactions: 1 user
Top