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BY MELISSA WEBER | SEPTEMBER 17, 2009
One of the most controversial issues in cancer during recent months has surrounded the question of screening (check out my screening post earlier this summer). The question seems simple enough: Does screening save lives? Ask most cancer patients and they'll say it does, but research says not so fast.
With the exception of colorectal, cervical, and breast cancers, research shows that current screening tests don't spare lives and can even be harmful in some cases. So why don't most tests work? What's a person to do if they want to be proactive about early detection? Well, it's complicated. Before you read any further, throw conventional wisdom out the door. Then check out the fall issue's "Life Preserver?" from contributing writer Laura Beil and "Cancer Screening" by Dr. Barnett Kramer, of the National Institutes of Health.
Among other things, these articles examine a fascinating trend called lead-time bias. Put simply, we get the false impression that we're living longer because screening diagnosed cancer early, when, in fact, the date of death doesn't change. Beil writes:
"Think of it this way: Imagine an asteroid is hurtling toward Earth, with impact at noon tomorrow. Satellites from an early warning system could have discovered it a year ago and tried to destroy it, giving a year's 'survival' with the asteroid. More sophisticated technology may have found it farther out in space, say seven years ago, giving seven years of 'survival' with the asteroid. Either way--a one-year survival or a seven-year survival--still means calamity at noon. Early detection didn't mean we lived longer; it just meant we knew sooner, and tried harder to stop it. Or we were working feverishly to stop it, and some other global cataclysm occurred first."
With all the screening tests that are currently available, if we know what doesn't save lives, why not focus on finding something new that does? The Canary Foundation, a nonprofit dedicated to early cancer detection, is making some interesting headway in this area (read more about the kind of research they're doing in "Screen Savers").
For now, there are a number of resources available to help you better understand the potential benefits and harms of a variety of cancer screening tests. This is a topic many are passionate about, and we welcome your comments.
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I hope it is acceptable for a male to respond. For us it is the PSA test along with the digital rectal exam. I am a retired pharmacy faculty member who taught biochemistry and some medicinal chemistry. When it comes to my health, I do not like surprises of a negative nature. I don't think the issue is whether or not to test (PSA is cheap!) but how to educate a patient when the PSA number starts to climb. Also, in the case of prostate cancer, there needs to be additional research on how to distinguish between a slow growing versus a rapid growing metastisizing cancer. Finally, quality of life needs to be considered. Several years ago, I watched my uncle die from prostate cancer. It was not pleasant, least of all for him. Had there been the PSA test and today's treatment options, it might have been caught early and treated. He might still have died at the same age, but he likely would have had a fuller, more productive life.
- Posted by John Block 9/17/09 3:51 PM
I've had two surgeries for invasive breast cancer in 2003 and 2007. It was a very fast-growing type and the surgeon ignored my request in 2003 to have a mastectomy to resect a 1.2 cm tumor. They waited more than 3 weeks to have the 'lumpectomy' after the scan. I went through 6 doses of chemotherapy and 33 rounds of radiation.
4 years later, when I felt very sick and went to the doctor, we found out the first surgery missed a small chunk of the cancer and what the following scans had always interpreted as 'scar tissue' was actually the cancer growing out of the residue tumor. So I went through double mastectomy and 6 doses of chemotherapy again to rid of the 2+ cm tumor.
My IQ had dropped more than 20 points because of all the chemo and radiation treatment and I had lost my job last year.
I think medical exams save lives - especially the self examination. Doctors are only human and can't help but have biased views toward their patients. I wish I had been more assertive and had requested for a 2nd opinion sooner.
- Posted by Jackie Swan 9/17/09 6:14 PM
My husband and I are all too familiar with cancer. I had thyroid cancer when I was 25. I am now 50. It's sad that there is not a decent screening method for that cancer. I felt horrid for a few years and gained a lot of weight before a lymph node swelled up on the side of my neck. An Obgyn had felt my thyroid a few years before and thought it was enlarged, but he sent me for no additional testing. If every doctor would just feel the thyroids of their patients, that might help. If enlarged, send them for ultrasound! I don't normally watch Oprah, but way before she announced she had thyroid trouble, I could see her enlarged thyroid!!! I figured that her doctors must have it under control. I guess no one noticed it until she finally found someone to figure it out. For heaven's sake, I saw it! But that is normally a semi-benign cancer compared to other cancers.
My husband was diagnosed with prostate cancer at age 44. He applied for more life insurance and they turned him down due to an elevated PSA He went to a urologist and he did the usual exam and also a biopsy. No cancer. But a year later, his PSA rose again, so the doctor thankfully did another biopsy. This time, the needles hit the cancer. Thankfully the cancer was still in both lobes of the gland and had not spread. If he had not applied for insurance, he would probably be dead now.
Then, at age 50, he decided to have his routine colon cancer screening. I never dreamed the doctor would come out of the room and tell me he found a cancerous polyp. It had to be sent for pathology, but he was 90% sure it was cancer, possibly stage 2. I was just sick. This was round 3 for us! My husband had the surgery and thankfully, it was only a stage 1. No spread and very slow growing. The screening was very much a lifesaver! I also had my colonoscopy and I had no polyps, so I am off the hook for ten years now.
If you apply for more life insurance, they draw blood and test for a lot of stuff. You can obtain a report from the company and in my husband's case, it was a life saver. Screening for prostate cancer starts at 50! He was 44.
When he had his colon cancer surgery, the surgeon said that he has people in their late 30's with colon cancer. It seems like a shame that they have no screening methods for younger people! Unless you're having symptoms, the insurance won't pay. By the time you have symptoms, you're in trouble! Not sure what the answer is on that.
- Posted by Linda 9/17/09 7:58 PM
My sister-in-law died one year ago this month from colon cancer. When she complained to her doctor for 4 months about coughing and not breathing normally he kept telling her she had seasonal allergies. She had a tennis-ball sized tumor pressing on her diaphram. She lived only 2 more years; surgery twice and dozens of chemo rounds. I refuse to believe that screening would not have given her a long life. I was diagnosed 5 years ago at age 50 with high-risk probably-localized prostate cancer. No symptoms, elevated PSA 3 years prior then suddenly rising. I've had prostate radiation twice, vaccine therapy, whole pelvic radiation, ADT, and chemo. Except for the first radiation and ADT, nothing's been "proven" as effective. Not even the screening. My PSA has been undetectable for a year and I am healthy with no treatment side effects. PSA screening plus extraordinary (and expensive and experimental) treatments saved my life and quality of life. No screening and a quack doctor killed my sister in law. I know two people who were saved from colon cancer (20 years ago and still living) because of screening. I also have a friend who had a successful prostatectomy last month, no symptoms, rising PSA. Screening costs money and that's what we as a society need to reckon with. If we're going to pour billions of dollars into war then I have no problem arguing for screening.
- Posted by Albert 9/18/09 3:11 PM
My wife was diagnosed with ovarian cancer in April, 2005 as a stage IIIC. Statistically, she had a 15%-30% chance of survival. I am happy to report that some 4 years and 5 months later; she has not had a recurrence and is considered disease free. Many of her ovarian cancer friends have not been as fortunate.
There is a blood test available for ovarian cancer called a CA125. It is not widely used as a screening tool because the medical community has considered it to be an unreliable test as it gives false positives and false negatives. It is my opinion that the medical community should reconsider its opposition to using this as a routine test for women over 50 years of age. If the test gives a false negative, we know nothing more or less than we did before the test. Further medical investigation is warranted. If the test gives a false positive, additional tests such as a vaginal ultrasound or CT scan can be used to determine if there is the possibility of ovarian cancer. For those patients with elevated levels of CA125 who do not have ovarian cancer, there is some other medical condition that begs treatment.
Think of the possibilities of finding more stage I cases with a 90% survival rate versus the typical finding of stage III or IV with a 5%-30% survival rate. I do not suggest that we should rely on the CA125 test indefinitely. Researchers are actively working on a more reliable test. Until then, let's use the best one we have.
- Posted by Steve Kellar 9/21/09 10:46 AM
My husband died almost 5 months ago from stage IV non small cell lung cancer. He was 52 years old and had a history of smoking-on and off-for about 35 years. He is a prime example of someone who could have benefited from early detection. As he was going through treament(of only 4 months) I read numerous articles regarding lung cancer. One thoracic surgeon's view was that people who are at high risk for lung cancer-long time smoking history, exposure to carcinogens etc-should have a CT scan as a screening. In that way more cases could be detected at a stage I level and could be treated with more positive results. I only wish I had read this article sooner. I would have paid out of pocket for the CT scan. When I think of all the tests available, I find it inconceivable not to use them for high risk groups. It would actually be cost efficient to diagnose abd treat people sooner rather than later.
- Posted by Patricia DeLury 9/21/09 11:18 AM
Prostate cancer screening saved my life. When my beloved brother was diagnosed with aggressive (Gleason 8) prostate cancer, it had already spread to his pelvic bones, making for a very poor prognosis. He survived less than five years. Because of his case, I changed my own screening (PSA plus rectal) to TWICE per year. Then I was diagnosed with aggressive (Gleason 9) prostate cancer. We apparently caught it early as all the tests for metastasis were negative. I was treated with external radiation plus hormone suppression. That was five and a half years ago and I am still testing as cancer-free.
If a man is harmed by overtreatment, that was a flawed decision by human beings, not the fault of the test. The biopsy report indicates whether the cancer is aggressive or not.
Since there is as yet no better testing procedure than the PSA, any man over 40 who does not get tested is simply playing Russian roulette with his life.
- Posted by Manny R 9/29/09 7:18 PM
I believe women should start having mammograms at the age of 40 years old not 50 as the "experts" are saying now. I am now 54 years old and have been cancer free since 2003. I was diagnosed with stage 1 breast cancer detected on a mammagram. It was so small myself, my husband, nor the surgeon could "feal" it. I did not have to take chemo but did about 30 rounds of radiation. I will continue to be screened every 12 months even if I have to borrow the money for the test! I am fortunate now to have health insurance...but as we all know that can change very quickly. I had no history of cancer in my family. I think the new news of waiting until a women is 50 years old is "political" and is a time bomb waiting to cause the survival rate to decrease. Get your tests when needed!!!
- Posted by Wanda 12/12/09 5:19 PM