today Wednesday october 12, 2011 18
you have to gamble on your health easy one — do it. Instead, both breast and abnormalities, which leads to the two is some debate about whether they really
prostate cancer screening are really dif- basic harms of screening: False-positive exist, my reading of the data is that they do,
ficult calls, and the statistical differences tests and overdiagnoses. but they are few and far between — on the
between them are only of degrees. False positives are really common in order of less than one breast or prostate can-
H GILbert WeLcH Personally, as a 56-year-old man, I both breast and prostate cancer screening. cer death averted per 1,000 people screened
choose not to be screened for prostate can- Approximately 15 to 20 per cent of women over 10 years. That’s less than 0.1 per cent.
E arly October brought two developments
in the world of cancer screening: The
beginning of Breast Cancer Awareness
cer (and, were I female, I believe I would
choose not to be screened for breast can-
cer). Some of my patients have made the
and men who are screened annually over
a 10-year period will have to undergo at
least one biopsy because of a false-positive
Overall, in breast cancer screening, for
every big winner whose life is saved, there
are about five to 15 losers who are over-
Month, with its calls for regular mammo- same choice, while others choose to be mammogram or PSA — prostate-specific diagnosed. In prostate cancer screening, for
grams for women, and a new recommen- screened. That’s okay, because there is no antigen — test. every big winner there are about 30 to 100
dation from the United States Preventive single right answer. It’s a matter of opinion to what extent losers. You may look at these numbers and
Services Task Force that healthy men not Screening is like gambling: There are patients with false-positive tests are losers decide that both tests are good gambles —
undergo screening for prostate cancer. winners and there are losers. And while the — the physical complications of biopsies or that both are bad gambles.
It’s a stark juxtaposition: Screening few winners win big, there are a lot more are generally short-lived. But they certainly Or you might try to distinguish be-
is good for women and bad for men. But losers. It’s easy to understand why. don’t benefit from the procedures. And in tween the two. Overdiagnosis is more com-
just how different are these two cancer When doctors screen for early can- the interim, they’re made to worry that mon following prostate cancer screening
screening tests? cer, all the incentives — cultural, finan- they have cancer. and is arguably more consequential, as
The answer is: Not very. Neither is like cial, professional and legal — line up in Overdiagnosis is less common, but there is a higher risk of long-term compli-
the decision of whether or not to be treated one direction: Don’t miss it. As a result, much more consequential because it leads cations from prostate cancer treatment. So
for really high blood pressure. That’s an doctors overreact to even the tiniest to unnecessary treatment. Screening finds maybe mammography is the better gamble.
abnormalities that meet the pathological Or you might make a different calcula-
definition of cancer, yet will never go on tion and consider what happens without
50 SEATS ONLY
to grow or cause any symptoms, let alone screening. For breast cancer the first sign
death. Sometimes patients choose to wait is typically a breast lump, which in most
and see if the cancer grows, but most opt to cases can now be treated very successfully.
treat it; once you’re told you have cancer, it’s (The real success in the war against breast
difficult to wait and see what happens next. cancer has been improved treatment, not
will be shared
Patients who are overdiagnosed are
the big losers here. They undergo surgery,
screening.) But the first sign of prostate
cancer typically occurs too late for the dis-
session radiation and chemotherapy unneces- ease to be treated successfully. So maybe
sarily. And then there are the associated PSA testing is the gamble to take.
complications: Chemotherapy can cause The truth is that neither test works
nausea and radiation can burn normal tis- that well. Even with screening, most people
sue; breast surgery can be disfiguring, and destined to develop deadly, untreatable
prostate surgery can lead to bladder and cancers will still do so. When it comes to
sexual dysfunction. breast and prostate cancer screening, there
Doctors don’t know which patients are no right answers, just trade-offs.
they are treating unnecessarily, but they ¢ tHe neW york tImes
HOW TO CREATE A SIX FIGURE INCOME
know how the unnecessarily treated pa-
tients got there in the first place — because H Gilbert Welch, a professor of medicine at
they were screened for cancer. the Dartmouth Institute for Health Policy
“Kishore M have helped thousands of “I turned $1,000 Now let’s consider the winners — those and Clinical Practice, is a co-author of
people to live the life they want by in 2 months.” who have avoided dying from breast or pros- Overdiagnosed: Making People Sick
teaching them how to trade. If you are Mona Mhd - mother of 8 kids tate cancer by getting screened. While there in the Pursuit of Health.
determined to take an active role in “I turned $750 into
security a solid ﬁnancial future, then $150,000 in 3 mths
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