This post was prompted by the recent headline, written after several years of research, showing that up to 4000 women per year are being over diagnosed, for breast cancer.This is something that I have always suspected would be the case, and I can see arguments both for and against.
There have also been calls for routine PSA ( Prostate Specific Antigen ) tests for men over the age of 50, as an early detection of prostate cancer. However, after many years of research, there still is no definitive answer as to whether, this is the right way to go forward.
There are several different views in this discussion. Firstly, the obvious one, is anything that saves lives is worthwhile! Secondly, in today’s economic climate, the total cost of screening millions of people.Finally, the emotional cost on ‘the worried well’.
Over the years I have spoken to many people that have been newly diagnosed, with various different cancers.In instances that were considered less serious, and in the ‘watch and wait’ category, most people were very keen to do everything they could, to be rid of the cells, and live, ‘cancer free’. Even if this involved, complicated surgery, and a tough regime of treatment. It had started to effect them psychologically.I call this category of patient ‘the worried well’.They could be unaffected, physically for years, maybe forever, but decide that they can’t live with a cancer diagnosis.
I mentioned above about a PSA test for men, and below are some interesting findings.
The United States Preventive Services Task Force has analysed the data from the PLCO, ERSPC, and other trials and estimated that, for every 1,000 men ages 55 to 69 years who are screened every 1 to 4 years for a decade:
- 0 to 1 death from prostate cancer would be avoided.
- 100 to 120 men would have a false-positive test result that leads to a biopsy, and about one-third of the men who get a biopsy would experience at least moderately bothersome symptoms from the biopsy.
- 110 men would be diagnosed with prostate cancer. About 50 of these men would have a complication from treatment, including erectile dysfunction in 29 men, urinary incontinence in 18 men, serious cardiovascular events in 2 men, deep vein thrombosis or pulmonary embolism in 1 man, and death due to the treatment in less than 1 man.
I liken this scenario, to being told someone else’s secret. You didn’t ask, but now you have information you didn’t really want, and have to make choices. Your life has changed! Do something, do nothing, just live with it?
Until we are able to be much more precise with the tests we do, patients must be more aware of their options, and the possible consequences of their choices. There certainly are many different opinions and differing outcomes.This is where it gets tricky! You can only make a truly informed decision, if you have all the information. Even then, as we know, everyone is different. what is good for one person, is not so good for another.
I feel that if we have the facilities and capacity to early detect disease, then we should use it, even if it does have it’s drawbacks. These will certainly improve, with more accurate testing procedures. I also think that knowing what we know now about over diagnosis, will accelerate our work in improving these tests. After all, they cannot take away breast screening now, and the pressure will only increase for a prostate test for men.
From what you have seen above, and if you were in charge of the health and finances in this country, what would you decide to do?