RE: Screens find little cancers not deadly ones
There are three main types of cancers, by prognosis:
1) The hyperaggressive type- if you have 3 cancer cells, one has already spread elsewhere. (Hyperbolic, but you get the picture.)
2) The general type- take a few years to become visible, and a few more years to spread.
3) The indolent type- grow very slowly and take a decade or more to spread, if ever.
If you get the first type, NO screening procedure will save you. You had just better hope this type has a good treatment option, such as with most childhood leukemias.
If you have the third type, screening will, indeed, be counterproductive, in that the treatment will probably be worse than the disease. You'll probably outlive the tumor's more symptomatic and fatal stages. Many prostate cancers fall in this group.
However, most cancers fall into the middle group, and, for these, screening and early detection will indeed save lives, and possibly allow less-radical treatments. Most breast cancers and colon cancers fall in this group.
Since most cancers fall in this middle group, screening is, indeed, generally worthwhile. As the ACS states, an informed patient discussing the proper use of screening with an informed doctor is the best way to decide which screening procedures to undergo. Reliance on the "latest" study in journals or the Internet, is not. After all, if these did not go against prevailing wisdom, they wouldn't be news and wouldn't make it to the everyday media, anyway. Many of these so-called radical new findings are later disproven, and only time and additional study will weed out those that are truly valuable.
Unfortunately, for many cancers, we have no screening studies that detect them before they've already reached the terminal stages, such as ovarian and pancreatic tumors.
So, yes, let's look for new and better screening procedures, and evaluate all current screening modalities with your doctor, but don't avoid all screening tests out of hand because of one article!
Otto Kunst, M.D.
