There is some debate about cancer screening, but when the majority of women who have no cervix are still screened for cervical cancer, hopefully we can agree that we’re screening too much.
What does it mean when a doctor’s group needs to clarify the guidelines for doctors? It means that the guidelines aren’t based on the available evidence, and that we’re screening willy-nilly. To quote the LA Times article: “About 6 in 10 adults submitted to a colonoscopy more often than they needed to. One-third of men who got a PSA test to screen for prostate cancer couldn’t remember being asked by their doctor to do so.”
The paper published in the Annals of Internal Medicine tries to make things sound more balanced: “High-value strategies provide a degree of benefits that clearly justifies the harms and costs incurred; low-value screening provides limited or no benefits to justify the harms and costs.” In other words, some cancer screening is useful, other cancer screening is not.
For me, as a consumer, I’m not interested in getting “low value” testing. No testing for cancer is without dramatic stress. If that test will save my life or my patients’ life, I’m all for it. But if it won’t impact my patients’ lives positively, then what I’ve done is harm my patient by testing unnecessarily. No doctors who have been tested themselves recommend the sleepless nights of waiting and worrying.
The thing I like best about the new guidelines is the focus on not testing patients who have already got a serious illness and a lowered life expectancy. I’ve seen patients in heart failure who are still be told to come in for a prostate cancer screening. They make me almost as mad as the patients who are in end-stage cancer who are advised to go on statin drugs because their cholesterol is a little high. At some point, we are simply becoming silly, and harming those who rely on us to watch out for their best interests.
If you can’t read the slide below, go to the original here.