Cancer Screening: Does It Really Save Lives?
2009 July
(NaturalNews) Anne is a good patient. She sees her doctor for regular
checkups, has yearly mammograms, Pap tests, and colon cancer screenings, and she
even paid for a full-body CT scan out of her own pocket. She figures she's doing
everything she can to make sure she doesn't get cancer.
Truth is, Anne is doing nothing to prevent cancer. Although cancer screening is
billed as a preventive service that saves lives, the best it can do is detect
disease in its early stages, when it is supposedly easier to treat.
Nevertheless, every year millions of Americans dutifully line up for their
screenings, completely unaware that they may be doing more harm than good.
For more than 15 years, I've been warning patients about the downside of
mammograms, PSA
testing, and the overall concept of
cancer screening.
It hasn't been a popular position. Today, however, there's a small but growing
band of researchers, clinicians, and expert panels who are speaking out against
the unbridled use of these tests. One of them, H. Gilbert Welch, MD, a professor
at Dartmouth Medical School, has laid out very persuasive arguments in an aptly
titled book, Should I Be Tested for Cancer? Maybe Not and Here's Why. In this
straightforward and well-referenced book, Dr. Welch raises several concerns
about cancer screening.
1. Few People Benefit From Screening
For starters, the majority of folks who are screened receive no
benefit. That's because, despite scary statistics, most people will not get
cancer. Let's look at
breast cancer as an example.
According to government statistics, the absolute risk of a 60-year-old woman
dying from breast cancer in the next 10 years is 9 in 1,000. If regular
mammograms reduce this risk by one-third-a widely cited but by no means
universally accepted claim-her odds fall to 6 in 1,000. Therefore, for every
1,000 women screened, three of them avoid death from breast cancer, six die
regardless, and the rest? They can't possibly benefit because they weren't going
to die from the disease in
the first place.
If mammograms worked as touted, death from breast cancer would be rare, since
three-quarters of American women 40 and older get regular screenings (a total of
33.5 million per year). The modest decline in the
death rate from the
mid-1970s, when
mammography was introduced, through the present can be attributed to factors
other than screening, such as changes in treatment and the dramatic decrease in
the use of Premarin and other cancer-promoting hormone replacement drugs. It
doesn't take a rocket scientist to figure out that mammograms do not
substantially reduce risk of death from breast cancer.
2. The Most Deadly Cancers Are Missed
The flip side is that some people who are screened get cancer and die
anyway. Test results aren't always accurate. Sometimes cancer is there, but it's
missed (false negatives). In the case of mammograms, it could be a question of a
poor-quality test or a radiologist who overlooked something. Even experienced
radiologists don't always interpret test results the same, and sometimes they
just plain get it wrong.
The most likely reason that cancer is overlooked, however, is due to the
nature of cancer itself.
The deadliest cancers grow
very rapidly. Screening can detect slow-growing cancers in their early stages,
but you can see how aggressive cancers could be missed if you're only looking
for them once a year. Depending on the cancer's growth cycle, it could crop up
just months after screening and be far advanced by the time the next test rolls
around.
3. The Pitfalls of False Positives
Far more common than false negatives are false positives-those cancer
scares that occur when you're told that your test is suspicious but, after
further evaluation, turns out to be nothing. False positives lead to
confirmatory testing such as ultrasound of the breast and prostate, CT scan of
the lung, colonoscopy, and colposcopy of the cervix. These tests are at best
inconvenient and at worst extremely unpleasant, as anyone who's had a
colonoscopy knows. They also often lead to biopsies, which are far more invasive
and could possibly promote the spread of cancer.
Unfortunately, false positive rates are incredibly high. For mammography, it's
close to 10 percent. For every 100 women screened, 10 will require further
workup. If you repeat this screening test every year for 10 years, your
cumulative risk of having at least one false positive rises to 65 percent. This
means that more than half of all women will get the terrifying news that their
mammogram is abnormal-the first step on the slippery slope of intervention.
False positive rates are high for PSA as well, especially among older men. Some
estimate that three-quarters of men who have a prostate biopsy based on an
elevated PSA level do not have cancer. And lifetime false-positive risk for Pap
smears is 75 percent.
Another consideration is the psychological trauma of cancer screening. Being
told you might have cancer is a harrowing experience, and the lag time between
retesting and getting a clean bill of
health can be months.
4. Unnecessary Treatment
Even worse than the sound and fury created by false positives is
unnecessary treatment. Yes, some lives are saved due to early detection and
treatment. But not all cancers are the same. Some are deadly, treated or not;
others are not fatal regardless of treatment. Dr. Welch calls the latter
pseudodisease-small, slow-growing or nonprogressive cancers that you'd never
know existed were it not for screening tests. Yet all too often, these innocuous
tumors are attacked with a vengeance, often to the detriment of patients.
A prime example is
prostate cancer. Since 1975, its incidence has more than doubled. But rather
than having an epidemic
of prostate cancer, what we have is an epidemic of detection. Although many more
men are being diagnosed and treated, the death rate from prostate cancer has
held steady at 3 percent.
It's human nature, when given a diagnosis of cancer, to want to get rid of it.
But prostate cancer treatment is not benign. Surgical complications include
difficulty urinating (17 percent), urinary incontinence (28 percent), and
inability to have an erection (more than 50 percent). Radiation damages the
rectum and can cause diarrhea and bowel urgency. Side effects of androgen
suppression range from sexual dysfunction to risk of diabetes and heart disease.
Much of this treatment is completely unwarranted. Remember, the majority of
prostate cancer is pseudodisease. Most men die with it, not of it.
What Tests Should You Get?
So which tests should you get and when should you get them? It
depends on who you listen to. Unfortunately, there's no clear consensus among
expert panels and advocacy groups, so confusion reigns.
I hesitate to make blanket recommendations. However, before you have a test, I
strongly encourage you to understand both the pros-the slim but potentially
lifesaving possibility that early-stage, clinically significant cancer will be
found and treated-and the cons-the high risk of false positives, additional
testing, anxiety, and unnecessary treatment. That way, you'll be better prepared
to deal with the outcome, whatever it may be.
Think Twice
I understand that this is an emotionally charged issue. Cancer is
scary and the treatments for it are as frightening as the disease itself. If you
have symptoms of cancer, by all means see a doctor and discuss appropriate
testing.
Otherwise, think twice. If your physician orders a cancer screening test,
question its necessity. Doctors sometimes suggest these tests for all the wrong
reasons: fears of malpractice, financial incentives, and even patient demand.
Find out what course would be recommended if your results were positive. Then
review the information in this article, read Dr. Welch's book, and make your own
educated decision.
Next time you hear that someone who died of cancer would have been saved if only
he'd had regular testing, realize that's nothing more than unsubstantiated
opinion. And, whatever you do, don't let anyone make you feel irresponsible if
you elect not to undergo cancer screening.
References
*SEER. Cancer of the breast. National Cancer Institute.
http://seer.cancer.gov/statfacts/ht... Accessed Sept. 2, 2008.
*US Preventive Services Task Force. Guide to Clinical Preventive Services.
http://www.ahrq.gov/clinic/cps3dix..... Accessed Aug 25, 2008.
*Welch HG. Should I Be Tested for Cancer? Berkeley, CA: University of California
Press; 2004.
Reprinted from Dr. Julian Whitaker's Health & Healing with permission from
Healthy Directions, LLC. For information on subscribing to this newsletter,
visit www.drwhitaker.com
or call (800) 539-8219.
About Julian Whitaker, MD: America's Wellness Doctor, Julian Whitaker, MD, is a
pioneer in
alternative medicine and founder of the Whitaker Wellness Institute in
Newport Beach, CA, the country's largest alternative
medicine clinic. Since
1979, Whitaker Wellness has helped more than 40,000 patients reverse serious
health problems with lifestyle changes, nutritional supplements, and other safe,
nontoxic therapies.
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