Flaws in Cancer Screening

Tom Emerick

Posted 4/24/12 on Cracking Health Costs

Lisa M. Schwartz, MD and Steven Woloshin, MD wrote a good article published in the New York Times called “Endless Screenings Don’t Bring Everlasting Health.” Click here to read the full story.

Many Americans have high expectations for avoiding cancer with the right regimen of tests.  After all isn’t that what our wellness programs teach us? Isn’t that what we hear trumpeted in the popular media? Getting such screenings on a regular basis just makes good sense, no?

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Screening – Illiterate Physicians May Do More Harm Than Good

Kenneth Lin

Posted 3/05/12 on Common Sense Family Doctor

On the first day of the clinical preventive medicine course that I teach every spring, I review the concept of lead-time bias and its potential to make a screening test look more effective than it really is (or, effective when it’s not). Frugal Family Doctor recently explained how lead-time bias deceptively improves 5-year survival statistics. If you are unfamiliar with this concept, I recommend reading his post, but the basic idea is that by advancing the time in the disease course that cancer (or some other condition) is detected, screening will always increase the percentage of patients who survive for 5 years or more, even if it doesn’t do anything to reduce mortality. This concept is as basic to the appropriate use of screening tests as vital signs are to the practice of medicine. In my opinion, any physicians who don’t understand lead-time bias ought to have their test-ordering privileges suspended until they do.

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It’s Time To Stop This [PSA] Screening Nonsense

Kenneth Lin

First published 6/21/11 on Common Sense MD

In an editorial in this month’s issue of the Journal of Family Practice, Northeast Ohio Medical University dean and family physician Jeff Susman, MD joins the rising chorus of voices urging clinicians to stop offering the PSA test to screen for prostate cancer. Dr. Susman writes:

I am going to go out on a limb here and suggest that, until we have fundamentally changed strategies for targeted case finding or early intervention (think genomic and proteomic markers), it is time to stop this screening nonsense. The facts speak for themselves: A trial of 182,000 patients finds in a post hoc analysis of a very narrow population that death can be averted in one of 723 individuals who are screened. What about the complications associated with diagnosis, work-up, and treatment? It is time for urologists and primary care physicians to tell patients that PSA screening is unlikely to benefit them. Some of you will suggest that we counsel patients about PSA testing to facilitate informed decision-making. But do we advise patients to play the lottery or try futile therapies? 

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