American Cancer Society Says Screening is Overrated?

[Iggy]

Rush was just talking about this. Blew me away:

http://www.nytimes.com/2009/10/21/health/21cancer.html?_r=1&hpw
The American Cancer Society, which has long been a staunch defender of most cancer screening, is now saying that the benefits of detecting many cancers, especially breast and prostate, have been overstated.

It is quietly working on a message, to put on its Web site early next year, to emphasize that screening for breast and prostate cancer and certain other cancers can come with a real risk of overtreating many small cancers while missing cancers that are deadly.

“We don’t want people to panic,” said Dr. Otis Brawley, chief medical officer of the cancer society. “But I’m admitting that American medicine has overpromised when it comes to screening. The advantages to screening have been exaggerated.”
This is disturbing since the US has the highest breast and prostate cancer survival rates in the world and that has been attributed to early screening.

But wait! The same guy just released a statement to refute what he said in the NYT story:
http://www.reuters.com/article/pressRelease/idUS191681+21-Oct-2009+PRN20091021
"The bottom line is that mammography has helped avert deaths from breast
cancer, and we can make more progress against the disease if more women age 40
and older get an annual mammogram.

"Since 1997 the American Cancer Society has recommended that men talk to their
doctor and make an informed decision about whether or not prostate cancer
early detection testing is right for them. This recommendation also still
stands.

So which is it?

[Stantz]

Early Breast Cancer screening, and a slightly obsessive personality saved my mother's life a few years back

I can't say enough good things about it

... ladies - feel up those cans for lumps, get it done !

... guys - swallow your pride and get the pit of doom checked up regularly as well

I'm not even joking.

[homiebrah]

I would bet Iggy's meager possessions that those who survived cancer after having it detected through early screenings would disagree with the knucklehead's assertion in the NYT article.

[Czhorat]

Did you read the entire article, Iggy, or did you just cherry-pick the quotes that let you rant? The message seemed pretty clear to me, and it's not a new one: screening is one of those things that, while it feels like the right thing to do, does not necessarilly lead to a long-term health benefit.

What was Rush's take on it?

[avergbear]

Strange the New York Times would come out with a story like this just as Obama wants to cut the cost of health care.

Remember how he told us that doctors were doing tests and cutting off feet just to make extra money?

This is worse than Death Panels.

[Rocket]

Strange the New York Times would come out with a story like this just as Obama wants to cut the cost of health care.

Remember how he told us that doctors were doing tests and cutting off feet just to make extra money?

This is worse than Death Panels.

I think you have it wrong. The point of health care will be that more people will have access to screenings like this and yearly visits for the purposes of preventing catastrophic illness and costs. Why would you be against that?

[Iggy]

Did you read the entire article, Iggy, or did you just cherry-pick the quotes that let you rant? The message seemed pretty clear to me, and it's not a new one: screening is one of those things that, while it feels like the right thing to do, does not necessarilly lead to a long-term health benefit.

What was Rush's take on it?

I read the whole thing. Did you read my entire post? I even included a link and excerpt from another article where the same guy is trying to make his message more clear without the spin from the New York Times.

"Cherry picking" indeed.

[RowdyTexan]

Well since my wife is alive today because of an annual exam I'd say to this guy, B******T!

It's like these morons are trying to make stupid the new smart. :rolleyes:

[avergbear]

I think you have it wrong. The point of health care will be that more people will have access to screenings like this and yearly visits for the purposes of preventing catastrophic illness and costs. Why would you be against that?

I guess you missed the story in the New York Times that is now telling us that these tests are over rated and to a large degree, unnecessary.

Isn’t the timing a little too... convenient?

[Czhorat]

I read the whole thing. Did you read my entire post? I even included a link and excerpt from another article where the same guy is trying to make his message more clear without the spin from the New York Times.

Spin from the NY Times? The Cancer Society message clearly states that screening for certain cancers can lead to overtreatment and does NOT lead to increase in survivability.

For example, from the article:


Prostate cancer screening has long been problematic. The cancer society, which with more than two million volunteers is one of the nation’s largest voluntary health agencies, does not advocate testing for all men. And many researchers point out that the PSA (http://health.nytimes.com/health/guides/test/psa/overview.html?inline=nyt-classifier) prostate cancer screening test has not been shown to prevent prostate cancer deaths.


Read the above' for prostate cancer in particular, they do not represent screening for all men, because overall it doesn't help.


If breast and prostate cancer screening really fulfilled their promise, the researchers note, cancers that once were found late, when they were often incurable, would now be found early, when they could be cured. A large increase in early cancers would be balanced by a commensurate decline in late-stage cancers. That is what happened with screening for colon and cervical cancers. But not with breast and prostate cancer.

THe basic thrust seems to be that many of the cancers found through early screening would not have been a problem anyway, and those that are truly dangerous often grow fast enough to appear between screenings.

What, may I ask, is your real issue with this? It seems to me that the research does not support the intuitive concept that screening is good. That's why scientists do research and don't just make gut judgements on what feels right.

[Iggy]

Spin from the NY Times? The Cancer Society message clearly states that screening for certain cancers can lead to overtreatment and does NOT lead to increase in survivability.

For example, from the article:

Read the above' for prostate cancer in particular, they do not represent screening for all men, because overall it doesn't help.

THe basic thrust seems to be that many of the cancers found through early screening would not have been a problem anyway, and those that are truly dangerous often grow fast enough to appear between screenings.

What, may I ask, is your real issue with this? It seems to me that the research does not support the intuitive concept that screening is good. That's why scientists do research and don't just make gut judgements on what feels right.
The guy felt the need to release a press statment making the American Cancer Society's stance clear after the NYT released the article. Why do you suppose that is?

[avergbear]

The guy felt the need to release a press statment making the American Cancer Society's stance clear after the NYT released the article. Why do you suppose that is?

Shirley you are not suggesting that the New York Times would spin this story to benefit the Obama Administration and the Socialization of American Healthcare?

[Czhorat]

The guy felt the need to release a press statment making the American Cancer Society's stance clear after the NYT released the article. Why do you suppose that is?

Do you have a link to the press release?

I'd guess it's because this is a complicated issue, and they don't want people to over-read the Times article and avoid all screenings altogether.

I just shake my head when people complain about scientific research that doesn't match their preconceived notions about what the answer should be.

[Metal Conservative]

I think you have it wrong. The point of health care will be that more people will have access to screenings like this and yearly visits for the purposes of preventing catastrophic illness and costs. Why would you be against that?

Until they deem it unnecessary and ration its use. Oh wait...I think that is what they are setting up here. Still don't get it.

[Iggy]

Do you have a link to the press release?

I'd guess it's because this is a complicated issue, and they don't want people to over-read the Times article and avoid all screenings altogether.

I just shake my head when people complain about scientific research that doesn't match their preconceived notions about what the answer should be.

The link is in the OP. Its at Reuters.

I am not trying to refute the study or its findings. I'm making a very different point...

You have to go down 9 paragraphs in the New York Times story to find anything positive about screenings: Still, the researchers and others say, they do not think all screening will — or should — go away. Instead, they say that when people make a decision about being screened, they should understand what is known about the risks and benefits"

For now, those risks are not emphasized in the cancer society’s mammogram message which states that a mammogram is “one of the best things a woman can do to protect her health.”


This is buried in a story headlined "Cancer Society, in Shift, Has Concerns on Screenings".

Dr. Brawley had to release a statement to make sure that anyone reading the NYT story would get the real message.

Now, why would the NYT publish a story that makes it appear the ACS is changing its mind on cancer screenings for the first 8 paragraphs?

[Iggy]

Shirley you are not suggesting that the New York Times would spin this story to benefit the Obama Administration and the Socialization of American Healthcare?
Shirley, that is exactly what I'm suggesting.

[Czhorat]

Now, why would the NYT publish a story that makes it appear the ACS is changing its mind on cancer screenings for the first 8 paragraphs?

Perhaps because the idea that cancer screening reduces cancer deaths is conventional wisdom, and there's little sense on wasting space in a front page news story to repeat conventional wisdom?


The fact is that there has been debate on screening for some time now; this is not a brand-new issue. In fact, this kind of analysis is one way in which money can be saved in the health-care system without changing any outcomes.

[texanlovestotravel]

Poorly written article for sure. The part that confused me was the 'risks' of early screening for breast cancer. A mammogram is pretty easy and low risk in my opinion. Or a follow up ultrasound. Pretty non-invasive procedures....

I think the article is just a crap writing job when you can't figure out what the he** someone is trying to say.

[Iggy]

Perhaps because the idea that cancer screening reduces cancer deaths is conventional wisdom, and there's little sense on wasting space in a front page news story to repeat conventional wisdom?


The fact is that there has been debate on screening for some time now; this is not a brand-new issue. In fact, this kind of analysis is one way in which money can be saved in the health-care system without changing any outcomes.
Cancer screening saves lives. According to the press release, the American Cancer Society stands by that. The New York Times article goes on for 9 paragraphs that the ACS has "concerns" about screening and does more than hint that it is going to change its stance.

Its funny that you should mention costs because I don't remember seeing anything about the cost of screening in the article. The reason I say it is funny is because I believe that is exactly the reason this story was written in the way it was.

Everyone knows the NYT is firmly planted in the back pocket of the Obama Administration. When Obama gets his wish and our health care system gets put in the hands of the government, they are going to have to do some cost cutting. I think this story is a precursor to getting people used to the idea that they don't need all these tests, that regular screening is unnecessary.

[Vic Daring]

Since I had a bit of a scare on a prostate cancer screening early this year, which caused me to do some reading at the right time, I actually knew this already.

Screenings are great, and it's not hard to find someone who will tell you either their life, or the life of a loved one, was saved because of them.

But. Screenings most often detect microscopic cancer cells that may or may not develop into a health problem. Something you would die with not from.

Statistically, the studies show that blanket screenings aren't doing a better job of detecting and treating life threatening cancers, than other methods. (Such as more selective screening of people with greater risk factors like family history.)


And yes, there are risks associated with over diagnosing and over treating. I had a follow-up test that was a minor surgical procedure and wound up with an infection. Not exactly life threatening, but I had a miserable day of fever that got as high as 103.

None of which is to say that you shouldn't be screened. Just that it's maybe something to discuss with your physician and maybe save yourself a couple tests.

[Iggy]

Since I had a bit of a scare on a prostate cancer screening early this year, which caused me to do some reading at the right time, I actually knew this already.

Screenings are great, and it's not hard to find someone who will tell you either their life, or the life of a loved one, was saved because of them.

But. Screenings most often detect microscopic cancer cells that may or may not develop into a health problem. Something you would die with not from.

Statistically, the studies show that blanket screenings aren't doing a better job of detecting and treating life threatening cancers, than other methods. (Such as more selective screening of people with greater risk factors like family history.)


And yes, there are risks associated with over diagnosing and over treating. I had a follow-up test that was a minor surgical procedure and wound up with an infection. Not exactly life threatening, but I had a miserable day of fever that got as high as 103.

None of which is to say that you shouldn't be screened. Just that it's maybe something to discuss with your physician and maybe save yourself a couple tests.
Wow. Scary. You're doing better now, I hope?

[Vic Daring]

Wow. Scary. You're doing better now, I hope?

Indeed. Thanks.

No cancer. The first test was for an indicator, and the reading was high. The follow-up, surgical test, was more definitive. But also more invasive.

[Czhorat]

The part that confused me was the 'risks' of early screening for breast cancer. A mammogram is pretty easy and low risk in my opinion. Or a follow up ultrasound. Pretty non-invasive procedures....

The "risk" is in performing unnecessary biopsies and even surgery or chemotherapy to treat cancers that would never have advanced or become life threatening.

This entire episode strikes me as a testament to the anti-intellectualism on the right; if it an issue isn't intuitive and doesn't have a simple answer that can be completely explained in one sentence, the Rush Limbaugh side of the Republican party wants nothing to do with it. Anything more complex than "screening good" or "screening bad" just goes over people's heads.

Read the article again, without your partisan blinders. SOME screenings are valuable and appropriate, some are a waste of resources, and some lead to unneeded treatments. The point is to use statistics to decide and understand which ones to use and which not to.

Regarding your contention on cost, Iggy, I think you have it exactly backwards: the fact that some treatments are not medically productive is the reason that evidence-based medicine is part of Obama's ideal health-care plan. The data informs the policy, not the other way around.