women

Save Your Life With Cancer Screening (Part 2)

- 7 Kinds Of Fruit That Pregnant Women Shouldn’t Eat
- How to have natural miscarriage
- Foods That Cause Miscarriage
- Signs Proving You Have Boy Pregnancy

Americans’ understanding of cancer screening is rooted in simplistic advertising campaigns from the 1950s and 1960s that focused almost exclusively on early detection, according to Brawley of the American Cancer Society. “Those messages were appropriate in their time, but the science has evolved and our ability to detect tumors earlier has progressed,” he says. “Unfortunately, the message hasn’t changed.”

“Early detection saves lives. The 5-year survival rate for breast cancer when caught early is 98%. When it’s not? 23%.”

“Early detection saves lives. The 5-year survival rate for breast cancer when caught early is 98%. When it’s not? 23%.”

Consider this message from a 2011 promotional campaign run by the breast-cancer nonprofit Susan G. Komen for the Cure: “Early detection saves lives. The 5-year survival rate for breast cancer when caught early is 98%. When it’s not? 23%.”

Those numbers deserve an Oscar for best use of misleading statistics, according to an August 2012 editorial in the British Medical Journal. “Just because you are diagnosed earlier doesn’t mean that you will ultimately live any longer,” says co-author Steven Woloshin, M.D., a director at the Center for Medicine and Media at the Dart-mouth Institute.

 
“Just because you are diagnosed earlier doesn’t mean that you will ultimately live any longer,”

“Just because you are diagnosed earlier doesn’t mean that you will ultimately live any longer,”

He provides an example: Imagine that 100 women receive a diagnosis of breast cancer after feeling a lump at age 67 and die at age 70. Their five-year survival rate is 0 percent. Now imagine that their cancer is detected at age 64 but they still die at age 70. Their five-year survival is now 100 percent, “even though,” Woloshin says, “no one lived a second longer.”

Survival statistics also tend to be in-flatted by over diagnosis or by finding cancers that won’t become deadly. The more cases detected, even harmless ones, the more people are designated as survivors.

Cancer screening remains stuck in a 1960s view of the disease.

That leads to what Welch calls the popularity paradox. “The more over-diagnosis, the more effective a test appears and the more popular it becomes,” he says. “It’s a vicious cycle.”

Komen still runs those confusing numbers on its website, and other messages that make screening seem more effective than it really is still abound. “This shows how numbers can trick you to believing that screening has a really big benefit even when it is small or even nonexistent,” Wholoshin says.

Cancer screening remains stuck in a 1960s view of the disease.

Cancer screening remains stuck in a 1960s view of the disease.

If you find disease-related statistics confusing, don’t feel bad. Many doctors don’t get them, either. In one study, researchers presented 412 doctors with what appeared to be data from two tests. The first showed a five-year survival rate that improved from 68 percent to 99 percent; the other, that the mortality rate dropped from two deaths per 1,000 people screened to 1.6 deaths. The doctors were three times more likely to recommend testing based on the first set of data than the second. But here’s the kicker: The data applied to the same test, PSA screening for prostate cancer. Many doctors didn’t understand that the five-year survival rate could make a test look better than it really was.

Experts we talked with said that there is a need for statistics to be presented more clearly. “We just need to be honest,” Chou says. “In the end, it’s about trusting people with the information and empowering them to make good decisions.”

So what’s the harm?

For many people, the risks of screening-over treating harmless cancers or undergoing additional tests and procedures only to discover a test was a false alarm –isn’t’ a big concern. After all, it’s better to be face than sorry, right? If following up on those red-herring results were simple and risk-free, that would be true. But you don’t have to look far to find cautionary tales.

For example, even though most men with prostate cancer will never die of the disease, many are understandably uncomfortable living with it. Research has found that almost 90 percent of men with PSA-detected prostate cancer wind up treating it with hormone therapy, radiation, or surgery. But treatment can have devastating repercussions, including in-continence and impotence.

Research has found that almost 90 percent of men with PSA-detected prostate cancer wind up treating it with hormone therapy, radiation, or surgery

Research has found that almost 90 percent of men with PSA-detected prostate cancer wind up treating it with hormone therapy, radiation, or surgery

At age 62, John James of Houston had his prostate removed after a PSA test and follow-up biopsy found cancer. “My initial reaction was joy that I was cancer-free,” he says, “but I do believe that the side effects of surgery were vastly underrepresented.

“There’s no point in brooding, and in the end, I am still happy to not have cancer, but did it save my life? Truth is, I’ll never know.”

J. Starke’s experience is less typical but underscores the idea that testing itself poses risks. Even though he described his PSA numbers as “on the low side,” Starke didn’t question his doctor’s recommendation to do a biopsy, then a flow-up about three years later when his reading inched up. “Once you decide to go down the road of testing, you follow it where it takes you,” he says. After the second biopsy he developed sepsis, a systemic infection that almost killed him.

The experience has left a mark. “I’m of an age when I should be going in for a colonos-copy, but I’m finding that I’m resistant to it,” he admits. “I’m a physician. I’m supposed to be rational, but that kind of experience has a long-lasting emotional effect.”

Though the numbers for mammography look better than those for PSA testing, the benefits for women in their 40s aren’t as significant as they are for older women. As a result, even experts disagree. For example, the American Cancer Society says that women should be screened every year starting at age 40. But the U.S. Preventive Services Task Force says they should generally wait until age 50 and then be screened every two years. European guidelines agree, as does the World Health Organization, though it recommends screening every year or two.

“Something we all agree on is that mammography saves lives,” Brawley says. “But women need to know the limitations up front. They need to know the risks of false positives and over-diagnosis.” And, he adds, presented with that information, “some women will choose to say no.”

S. Kesler, 47, a teacher in Fredericksburg, Va., knows the downside of screening. After undergoing mammography for a few years, she switched to a clinic that recommended more aggressive follow-up for breast calcifications, abnormalities that are typically worrisome only when they form suspicious clusters. Kesker was called back for mammograms every six months and eventually a biopsy. But what should have been a simple procedure to obtain a tissue sample turned into a 4-hour ordeal in which she was strapped to a table, subjected to multiple punctures, and X-rayed so many times she lost count. The tests found no cancer. “I am normally very tough, but the experience left me totally shaken,” Kesler says. “And I still can’t get anyone to tell me how much radiation I was exposed to.”

 

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