Discussion on:

Screens find little cancers not deadly ones

The ACS is taking a conservative view, and has only re-emphasized the importance of discussing screening with your doctor. Other than that, their recommendations are unchanged.

See their press release on this issue:
http://www.cancer.org/docroot/MED/content/MED_2_1x_American_Cancer_Society_Stands_by_Its_Screening_Guidelines_Women_Encouraged_to_Continue_Getting_Mammograms.asp

Here is ABC's story http://abcnews.go.com/WN/CancerPreventionAndTreatment/breast-prostate-cancer-screening-criticism-stirs-debate/story?id=8881664

Headline: Cancer Society Catches Heat for Breast, Prostate Cancer Screening Criticism

The statements in the article submitted are old news - it has been known
for years (decades?) that screening causes ?overdetection? and thus
?overtreatment? of cancers that might be inert enough not to require
medication (?might? because we still can not discern the ones that do from
the ones that do not thus being forced to treat all of them). That is the price
we pay for getting more of the ones that call for aggressive treatment. So, I
am afraid, the phrase ?not getting help on cancers that will? is nonsense on
the border of cretinous - the only reason someone might not get the help in
this instance is because the resources are inadequate, not because of
screening itself as one might conclude from the text, but that should be
resolved by getting more funding, not by saving where You can not discern
on whom You can save and on whom You can not. This article smacks of
ammo for those whose prime interest is health politicking over money, not
medical help.
Also, the phrase ?cancers that won?t kill them and ... cancers that will? imply
two biological cancer groups that had been proven to exist in the prostate
and the thyroid - the aggressive and the non aggressive ones. No such
indication had been found for breast cancer. Thus, if it is true that statistics
has not shown any betterment in life expectancy for prostate cancer (and I
am not sure even if that is true) it is because the help that actually did occur
was in such a relatively small number of cases in respect to a vaster
amount of those for whom it was irrelevant that the result was
mathematically ?drowned? (a statistical effect that can be considered
artefactual). That can not hold true for breast cancer. If the lack of betterment
is true, the reason must be elsewhere - ineffective therapy, change in the
biological character of breast cancer in the population over time (historically
it happened in some other cancers), or some reasons not yet identified.
Methinks, the only sensible way to resolve this will happen when genetical
testing of cancer character (aggressive vs. non aggressive) will come into
clinical use, hopefully in the next 10-15 years.

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.