Screening tests: Benefits vs. harms

[WendyBG]

Many METARs are of an elderly vintage. All of us want to avoid dying of detectable diseases but we also want to avoid the potential harms of screening. These harms include additional testing and possibly damaging surgery to treat a slow-growing cancer that wouldn’t have caused death if left alone.

https://www.nytimes.com/2022/07/17/health/cancer-overtesting…

**Do Cancer Centers Push Too Many Tests?**

**Studies found that centers provided incomplete or unbalanced information, which could lead to unnecessary screenings and health complications in older adults.**
**By Paula Span, The New York Times, July 17, 2022**

**...**
**Screening refers to tests for patients with no symptoms or evidence of disease, including prostate-specific antigen tests, mammograms, colonoscopies and CT scans....The harms of screening occur early. But the benefits of screening can accrue years later; older patients with other health problems may not live long enough to experience them....**

**Guidelines from both the Preventive Services Task Force and the American Urological Association state that men over 70 should not be routinely screened for prostate cancer, because, according to the Task Force guidelines, “the potential benefits do not outweigh the expected harms.” ...**

**The Preventive Services Task Force’s 2016 guidelines, which are currently being updated, recommend screening mammograms every other year for women aged 50 to 74; it found insufficient evidence of benefit and harms for those 75 and older....**

**Lung cancer screening is recommended only for those at high risk because of smoking history and older age...** [end quote]

ePrognosis is a doctor-oriented web site that has a section on screening.
https://eprognosis.ucsf.edu/index.php

Many people don’t like to discuss their life expectancy so it might be hard for doctors to say, “This cancer might kill you in 10 years but you probably won’t live that long anyway.”

And cancer centers make a lot of money from screening, tests and treatment.

This topic has Macro significance because millions of people and billions of dollars are affected.

Wendy

[VeeEnn]

Excellent overview on n the topic. Cancer centers are particularly aggressive in this direction-to-consumer advertising cunningly disguised as keeping (potential) patients informed of their options…without any sort of nuance.

Many people don’t like to discuss life expectancy so it might be hard for doctors to say "This cancer might kill you in 10 years…

There’s definitely that. However, the glorified infomercials out of these joints seem to me to be remarkably similar to those Kevin Trudeau ads that resounded with phrases like “Your doctor doesn’t know this…” in order to peddle his evidence free and evidence proof products. Since no one cares to admit that they’ve been bamboozled by slick marketing, it’s quite common for anyone who might suggest that the impression the patient is under (that “regular” oncology is dragging its feet over the latest testing, supplement use or intervention) is automatically one of the naysayers. Cancer is probably the most obvious example…and there’ve been plenty of examples on the Health and Nutrition board over the years…

…and I say this in spite of the irony of requesting somewhat non standard testing without obvious reason myself, and discovering a situation that will hopefully be mitigated by meaningful intervention.

[pauleckler]

OK, but colon cancer and breast cancer are both major killers. Early detection gives better out comes.

Testing may not be for everyone, but it is useful information. At least the tests are available.

Maybe they do too much testing. But one would hope people get at least one of the screening tests.

And we would hope that tests for more cancers will follow.

Vaccines for cancer are in development. They too could be a source of longer life expectancy.

And then there’s DNA tests for vulnerable genes. So far seems controversial. But maybe one day.

[telegraph]

"OK, but colon cancer and breast cancer are both major killers. Early detection gives better out comes.

Testing may not be for everyone, but it is useful information. At least the tests are available."

I had two regular colonoscopies in my 50s and 60s. First found a few benign polyps…second none. No family history of cancers. in my 70s, doc recommended to Cologuard home test which I did. Covered by Medicare and not sure of how much the price.

Yes, know a bunch of females that died from breast cancer, even though it was ‘caught’ reasonably early. Some are too aggressive to survive. Some caught too late to do much.

Better tests will come.

You can do a lot by eating a healthy diet to minimize your chances of getting cancer…

https://www.amazon.com/Eat-Live-Amazing-Nutrient-Rich-Sustai…

Now a days, you can do a lot to avoid health issues by NOT BEING OBESE (like 50% of the population now overweight or obese)…

t.

[steve203]

Meanwhile, here in Michigan:

Farid T. Fata (Arabic: ??? ???, born 1965) is a Lebanese-born former hematologist/oncologist and the mastermind of one of the largest health care frauds in U.S. history. Fata was the owner of Michigan Hematology-Oncology (MHO), one of the largest cancer practices in Michigan. He was arrested in 2013 on charges of prescribing chemotherapy to patients who were healthy or whose condition did not warrant chemotherapy, then submitting $34 million in fraudulent charges to Medicare and private health insurance companies over a period of at least six years.

https://en.wikipedia.org/wiki/Farid_Fata

We live in a Shiny culture, rife with information asymmetries, and a profit motive that has been deified.

Steve

[tjscott0]

Our health care system has medicalized old age.
I would recommend read the following:
“The Last Well Person” by Dr Norton Hadler he covers many established medical procedures that do not extend life & unnecessary tests.
“Overtreated” by Shannon Brownlee
“Know Your Chances” understanding health statistics
“Should I Be Tested For Cancer?” Maybe not & here is why