Wednesday, October 21, 2009

Cancer Screening

In yesterday's New York Times, there is an article that discusses just what is gained from screening for prostate cancer and breast cancer. This is an interesting topic, because I have (honestly) been puzzled by the term overdiagnosis of cancer in the past.

What does this article tell us? It tells us (reporting on a recent study in the Journal of the American Medical Association) that screening for prostate cancer has led to a lot more diagnosis of early stage cancer but not so much less diagnosis of late stage cancer and not so much of a decrease in deaths due to prostate cancer. While there has been some debate about prostate cancer screening that has made it to the popular press for years, the fact that questions are also being raised about breast cancer screening is a relatively new point in the general popular press.

What does this mean? We spend a lot on screening as a society. We spend a lot on treating early storage cancers. We have changed late stage outcomes less than might be expected. We create risks for people by treating them early.

Does this mean that screening is not cost-effective? Not necessarily. It only means that some cancer screenings are not the ultimate solution for the relevant cancers. And it suggests the need for more research that will help medical care practitioners to identify which cancers are more likely to be dangerous to the patients and which cancers are less likely to be dangerous. If this could be figured out and the treatments could then be directed only to those most at risk for adverse consequences of rapidly growing cancers, the cost-effectiveness of the combination of screening and treatment could be greatly increased.

It will be interesting to see how this discussion continues to develop and what medical care practitioners and the general public make of the changes in the tradeoffs that this implies in the future.

1 comment:

  1. The US Preventitive Task Force makes recommendations yearly regarding screening. In general screening men older than 75 for prostate cancer is not recommended yet the public has not been educated. Defensive medicine and provider induced demand dictates preventitive screening. A
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    Renee- Pace DNP cohort