I've discussed lay press articles before, particularly with regard to the New York Times piece on the missed diagnosis of breast cancer. That article was a goldmine of oversimplification and improper emphasis.
However, the June 3rd issue of Time Magazine
, which is devoted to health care in general and cancer in particular contains an article by Kate Pickert entitled, "The Screening Dilemma."
This is the most succinct, best written article on the problems of cancer screening that I've encountered in decades. Virtually every aspect of screening is covered, from the viewpoints of patients, the insights of physician specialists, and the economic incentives that drive these processes. I strongly recommend that you read this and pass it on to your non-physician friends, particularly if they are "screenophiles."
Here are just a few quotes from the article to pique your interest:
"If we had a 100% sensitive test that could pick up everything a pathologist would call cancer, it's conceivable that most of us, if not all of us, would be found to have cancer."
"The problem... is that "there are really bad cancers and there are really innocuous ones that never go anywhere, and we're not good at sorting them out."
"Cancer screening is truly effective only if the growths found would eventually cause sickness and if finding those growths earlier increases the efficacy of treatment. Absent these two conditions, finding cancer via screening is what's known as "overdiagnosis," which is guaranteed to happen when screening is performed population-wide. Overdiagnosis causes harm ranging from unnecessary worry to death in rare instances."
"Here are the odds. To save the life of one woman in her 40s, 1,904 would have to undergo annual screening. Beyond inconvenience and overexposure to radiation, this excess mammography would lead to false positives; psychological stress, including depression; and unnecessary surgery. In addition, much of the abnormal cell growth detected in women in their 40s could have been detected in their 50s with no adverse effects from the delay."
"Multiple scientific trials have proved that the ubiquitous prostate-specific antigen (PSA) test saves very few lives, if any. PSA tests are notoriously unreliable, detecting potential cancers where there are none and returning normal results in some men who have malignancies. The doctor who discovered the existence of PSA,a protein that, when elevated, is sometimes an indication of cancer, has disavowed the test, calling it a 'profit-driven public-health disaster.'"
...there are many more.
I especially recommend reading the section by Dr. Jim Mold about his accidental PSA screening and getting caught in the resultant "cascade effect."
Near its end the article discusses two of the most rapidly rising cancers, at least in terms of diagnosis, thyroid carcinoma, and melanoma.
"Remarkably, many of us, possibly even most of us, will develop thyroid cancer at some point in our lives, but very few of us will die of it. In a 1985 study, researchers examined the bodies of 101 people who had died of causes other than thyroid cancer and found that a third of them contained cancerous thyroid cells. Because of the sampling method, the researchers knew that they were certainly missing some cases, meaning the percentage was even higher, and yet none of those people were killed by the disease."
Finally, theres a section on the seldom discussed economics of screening.
...but enough said, go read it!