I have been immersed in preparing a talk regarding cancer screening for the Alabama Academy of Family Medicine Annual Meeting in San Destin in June. I invite you to come and hear the whole thing. It is about cancer screening and I believe that I may offer an updated perspective.
I don’t want to give the whole thing away except to say I was inspired by a paper published recently in the Annals of Internal Medicine entitled “Do physicians understand cancer screening statistics?” The answer was “no, but” (more on that in a later post). Some facts that amazed me were in another paper I found about people’s enthusiasm towards cancer screening.
To paraphrase (my comments in italics):
In general, Americans believe cancer is very common and screening very effective and in general over half assume that early detection is synonymous with cure. The reality is that this is only true for certain cancers at certain stages. Half of Americans assume that seeking out tumors that will never become symptomatic is important. I can only hope they don’t understand the word symptomatic. Lastly, over 40% of Americans assume that screening for cancer is appropriate regardless of age. When questioned they profess a belief that an 80 year old who has no problems has a duty to be screened with a PAP and a mammogram if a woman and PSA if a male. This despite clear evidence that these tests offer very small individual benefit effect (on average about 1 in a 1000 for mammography and PAP smears and none for early prostate cancer detection) and what effect there is happens after 10-15 years.
Perhaps we have oversold screening…