Should I Be Tested for Cancer? Maybe Not and Here's Why
I just finished reading Should I Be Tested for Cancer? Maybe Not and Here's Why by H. Gilbert Welch, MD, MPH, professor in the Departments of Medicine and Community and Family Medicine at Dartmouth Medical School.
It is truly an eye-opener. A brief summary follows, but first here's an editorial review from the New England Journal of Medicine:
"The author maintains that cancer screening may have been oversold to the public and health care practitioners alike. By challenging commonly held assumptions, Welch stimulates a critical dialogue between patients and providers regarding the effect of screening on cancer-associated morbidity and mortality, the sequelae of false positive results, and the slippery slope of diagnosing and managing incidentally detected cancers, many of which may pose no immediate health threat. To balance this cautious approach to cancer screening, the author acknowledges the successes of rigorously proven screening methods and weighs them against the high costs that invasive cancer imposes. Indeed, leading health economists recently estimated that as little as a 10 percent reduction in cancer would translate into a savings of $4.4 trillion to society.
"This book, which offers a sobering view of the status of cancer screening today, deserves to be widely used by patients and providers as they navigate an expanding and often bewildering array of screening options. Nevertheless, improvements in our understanding of carcinogenesis, enhanced performance characteristics of early-detection technology, and noninvasive approaches to diagnosing early neoplasia are likely to narrow the gap between the detection of disease and its appropriate medical management. These advances are likely to recalibrate the risk-benefit ratio of cancer screening. Indeed, transient uncertainties and potential harm should serve as an impetus for scientific advancement, rather than as evidence of conceptual failure. In an evolutionary sense, the dilemmas so well detailed in this book may be viewed as natural preconditions for continued progress." -Jaye L. Viner, MD, MPH
Millions of people are being screened for cancer every year, but is it really necessary? Is it really making a difference? Are people harmed by these tests in any way?
Dr. Welch explains brilliantly what these cancer screenings really mean. He argues that we are taking healthy, symptom-free individuals and looking for cancer.
Here's what most people don't know:
There is no evidence that these screenings have actually saved lives. In fact, despite increased detection of early stages of prostate cancer and breast cancer, the death rate for prostate cancer has stayed the same and the rate of late-stage breast cancer has increased over a twenty-five-year period.
Autopsies of people who have not died from cancer have shown cancer in the lungs, thyroid, kidney, and so on. This means that millions of people live with cancer but die of another cause without ever knowing they had cancer.
If the screening finds cancer, it does not necessarily mean that it is the type that will grow rapidly. a. It could regress on its own, as the immune system eliminates abnormal cells, including cancers, regularly. b. It could stay the same for many years and never cause a problem. c. It could grow so slowly that it causes no health problems and the person dies of something else before it can.
Studies conducted by Johns Hopkins, Harvard, and others have shown that different pathologists give different diagnoses for the same tissues. They may look at the same tissues and some will think it is cancer while others will think it is not. This is especially true when it comes to the few abnormal tissues taken in screening a healthy individual.
Between screenings, it is possible to develop a fast-growing cancer. So how often do we need to do mammograms and colonoscopies?
The statistics, such as the five-year survival rate, are not always reliable and might be calculated in a misleading manner.
So you have a mammogram, PSA test, colonoscopy, or fecal occult test done. This is what might happen:
You end up with a false positive. Although it varies from test to test, a 10 percent false positive rate is the average.
You get the cancer scare unnecessarily.
This can begin a cycle of retesting, biopsies, and other tests. Some can be very unpleasant and have side effects.
If they find abnormal tissues, what does it mean? Maybe the pathologist made a mistake, maybe the cancer has been there for many years; maybe it is a slow-growing cancer; maybe it will go away on its own, or maybe it is a fast-growing cancer! Of course, your doctor can't take a chance with your health, and also does not want to get sued for malpractice, so most likely he or she will recommend the most safest (which could be the most aggressive) course of action!
Here you were, living a relatively healthy, symptom-free life, and now you are told you need surgery, radiation, or chemotherapy.
Once you know that cancer has been found, it is hard to know what to do-not to mention the emotional toll of the diagnosis. That's why Dr. Welch believes sometimes it is better not to know.
Caution: If you have any unusual symptoms, such as a lump in your breast or blood in your stool, and your doctor recommends testing for cancer, make sure you are tested.
After reading the book, I decided I do not need any screening. As long as I am symptom-free and healthy, why put myself through tests that might (or might not) extend or save my life-or that might harm me. As long as I don't do anything to harm my immune system, such as smoking, and instead do the things that enhance my immune system, such as exercise, I believe that I don't need to become a patient.
Each individual needs to make a decision about cancer screening based on his or her priorities, family history of cancer, and other factors.
My recommendation is to read the book and consult your doctor for your best options.
Another good book on this topic is Seeking Sickness: Medical Screening and the Misguided Hunt for Disease by Alan Cassels and Dr. H. Gilbert Welch.
Stay informed. Stay well.
Fred Amir
