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medpundit |
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Tuesday, April 09, 2002Con: “The problem, Dr. Kramer said, is the numbers of cancers found early and found later, corrected for size and age of the population. If screening worked perfectly, every cancer found early would correspond to one fewer cancer found later. That, he said, did not happen. Mammography, instead has resulted in a huge new population of women with early stage cancer but without a corresponding decline in the numbers of women with advanced cancer.” Pro: "In some situations, it may be that early diagnosis is important and in others it is not," Dr. Norton said. But until there is a way of sorting out which tiny tumor is dangerous or until treatment gets so good that it does not matter when a tumor is found, early diagnosis makes sense, he said.” Con: “Dr. Brawley said the data indicated that the test was finding tumors that would not be noticed and would cause no medical problems. But these tumors look exactly like dangerous ones. "There are cancers that fulfill all the histological criteria for malignancy," Dr. Brawley said. "When a pathologist looks under the microscope, he says, `Yes, this is cancer.' " But these tumors are not dangerous, and many that are dangerous may not be cured by early diagnosis and treatment. "The concept that every cancer that can be found early can be cured is a faulty concept," he said.” Pro: "Yes, there are probably some people who are treated unnecessarily," he said. "But all of medicine is that way. Is there a chance that when you have your appendix removed it will turn out to be normal? Yes." The standard position on prostate cancer screening has been to provide the patient with the pros and cons of testing and let him decide if it’s worth the risk. In breast cancer screening, there is no such discussion. Women are just told they should have it done and handed an order. Brochures on the topic from my own professional academy illustrate this. Compare the one on prostate cancer to the one on breast cancer. Furthermore, women who decline to have mammograms done are often nagged by their insurance companies and their doctors to have them done. Insurance companies even make decisions on the quality of care a doctor provides based on the percentage of his patients who have mammograms each year. The reason for this difference is that prostate cancer doesn’t have a powerful interest group to sway opinion as breast cancer does. It’s time to rethink our position on the absolute value of breast cancer screening and give women a chance to decide for themselves if the risk of screening is worth the effort. posted by Sydney on 4/09/2002 06:19:00 PM 0 comments 0 Comments: |
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