“We don’t want people to panic,” said Dr. Otis Brawley, chief medical officer of the American Cancer Society. “But I’m admitting that American medicine has overpromised when it comes to screening. The advantages to screening have been exaggerated.”
If breast and prostate cancer screening really fulfilled their promise, the researchers note, cancers that once were found late, when they were often incurable, would now be found early, when they could be cured. A large increase in early cancers would be balanced by a commensurate decline in late-stage cancers. That is what happened with screening for colon and cervical cancers. But not with breast and prostate cancer.
Still, the researchers and others say, they do not think all screening will — or should — go away. Instead, they say that when people make a decision about being screened, they should understand what is known about the risks and benefits.
“The issue here is, as we look at cancer medicine over the last 35 or 40 years, we have always worked to treat cancer or to find cancer early,” Dr. Brawley said. “And we never sat back and actually thought, ‘Are we treating the cancers that need to be treated?’
The very idea that some cancers are not dangerous and some might actually go away on their own can be hard to swallow, researchers say.
“It is so counterintuitive that it raises debate every time it comes up and every time it has been observed,” said Dr. Barnett Kramer, associate director for disease prevention at the National Institutes of Health.
Interesting. This is one of the challenges of modern medicine. Once something looks promising, we rev up the Public Health engines and invest millions in constructing the proper messaging so that everyone in America knows that women should get a mammogram and men should get a PSA. Then, after a few more decades of research, the stats blip in the other direction. And then the message gets reversed. It’s quite the PR nightmare that I’m sure contributes to western medicine’s legitimacy.
Essentially what I’m saying is that someday we’ll all sit back and remember the days we thought large scale studies in a healthcare system that’s 80% run on paper was a good idea.