Myth 1: There is no harm in routine cancer-screening tests.
Screening the general population for breast, prostate or other cancers requires weighing the potential benefit of finding a malignant tumor early on—when it is smaller and generally more treatable—against the very real harm of subjecting a lot of people to invasive and/or expensive follow-up procedures that they do not need.
Studies have shown that as many as half of healthy women will receive a false-positive result for breast cancer after 10 years of routine mammogram tests. (A false positive occurs when a diagnostic test tells you that you have a particular ailment, but in reality you do not.) Most of the false-positive group will then have to undergo a more detailed imaging scan and a significant fraction will undergo a biopsy—not to mention dealing with the anxiety of awaiting results.
Mammograms have helped to lower the risk of death from breast cancer. The prostate-specific antigen (PSA) test to screen for prostate cancer, however, cannot even lay claim to such a benefit. Originally developed to help track the recurrence of prostate cancer after the original tumor had already been diagnosed and treated, PSA tests are now widely used as a screening test to pick up unsuspected cases. The only trouble is that two studies (one from the U.S. and one in Europe) have shown that using the PSA test to screen for prostate cancer in this manner does little to decrease death rates in men aged 55 and older. Indeed, the discoverer of PSA has campaigned for years to get people to stop using the PSA test to screen for prostate cancer. (It still makes sense, however, for many men who have a strong family history of the disease or who have actually developed prostate cancer in the past.)
Basically, the more screening tests for different kinds of cancers you undergo, the greater your risk of getting a false-positive result. One study found that half of all people who received at least 14 tests for some combination of prostate, lung, colorectal and ovarian cancer had been given a false-positive result. And men and women with a false-positive test had a one-in-four chance of having to undergo a surgical procedure—with its own attendant risks—to find out that they were okay after all.
» Next: Myth 2: More care is better care
« Previous: Myth 1: There is no harm in routine cancer-screening tests
Credit: Corbis
See what we're tweeting about
20 Comments
Add CommentComparative effectiveness research is a nice idea, however when an individual applies for Social Security disability their creditability is established by having numerous visits to a physicians and a dependance on prescription medications.
Reply | Report Abuse | Link to thisAn individual that manages their disability, especially after decades of having several debilitating conditions, will have a significant uphill battle is getting disability.
If eliminating excessive medical 'care' is to be beneficial across the board then the penalty on individuals that do not reach retirement before their prevents employment must be addressed.
The archaic statutes that govern Social Security disability need to be amended eliminate the preference for passive maladaptive management techniques.
Yeah, #4 is in no way proof that we are the worst. Doesn't #3 say more comes into play?
Reply | Report Abuse | Link to thisWhen world leaders and other wealthy individuals stop coming to the US for specialized care, then I'll believe that number 4 is a myth.
Reply | Report Abuse | Link to thisLifespan is a product of a host of factors, only one of which is access to good medical care. More important are lifestyle choices, obesity and genetics. Yet lifespan is the primary measure to dispute that the US has a great healthcare system. Perhaps the author should re-read myth number 3.
Reply | Report Abuse | Link to thisHealthcare for the upper elite for various specific illnesses may be better in the US but that is not true for most people.
I've known quite a number of people who have LEFT the US to get healthcare. Most of this reason is because of cost.
There are cultural difference to take into account; but, lifespan IS the best comparison of overall health.
We truly have a bad system in the US.
For all the complaints about "big government" and "socialized" medicine- the simple fact remains that every country in the world that has a national health service also has a longer life-expectancy than the US.
Every country that has government provided health care spends less than the US. For the vast majority of these countries the average cost per capita for health-care is approximately half that of the US.
So- pay less, live longer. :)
Now, I don't think it is government that drives cost down specifically (they usually do the opposite)- rather the absence of the insurance feedback loop. I would be fine without a national service- but medicine does need a complete overhaul- we're on a non-sustainable path.
Generally in the US, the consumer does not pay the bill directly or does not know how to shop around for best value- this enables the medical provider to overcharge.
Insurance companies are judged on how wide their networks- so the emphasis is to include over-priced doctors. To do this- they have to raise their prices.
We do not live as long as others because we have many more conveniences that allow us to be more sedentary. We walk a lot less than people in other coutries because we "all" have automobiles. We get a lot less exercise in everyday living.
Reply | Report Abuse | Link to thisI don't understand your logic. Isn't increasing longevity the most general criterion for judging health care effectiveness. I'm not discounting quality of life considerations, but according to the UN survey we are higher, 4th, but still not the best. The article doesn't even cite infant mortality figures. Care of the helpless doesn't get more basic than that. This is an indication of care of the unborn and the recently born the USA. According to the most recent CIA report, the USA is presently, BRACE YOURSELF: 46th of 222 countries in the world, at 6.01 deaths per 1000 births. (Environmental polution might be a factor here,admittedly.)
Reply | Report Abuse | Link to thisCHECK MY DATA:
https://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html
#1 - If you give me a choice between finding my breast cancer early while it's still very treatable versus not having to undergo a biopsy and a couple of weeks of wracked nerves for a false positive, I'll take take the risk of the false positive. Call me crazy but I'm rather fond of living, even if it means I have to experience a couple of weeks of severe anxiety. You've left out the "comparative" part of the "comparative effectiveness" - how many lives are saved each year because of routine mammograms? If that number is higher by even one person than the number of people who die from the results of a false positive, then it's absurd to think it's better not to have them.
Reply | Report Abuse | Link to this#2 - You didn't disprove that more care is better than less care. You proved that proper care is better than improper care (it is improper care to prescribe antibiotics when they're not needed) but doesn't common sense tell us that?
Pretty shoddy work on this one.
It really just might be that we have more bad habits and eat less healthy foods in their natural state. Has anyone included reports on what percentage of the population need (need: meaning that they would actually benefit from what care is offered.)compared to other countries. Of course you would have to exclude vaccinated instances when comparing to other counties who have not the same vaccine care.
Reply | Report Abuse | Link to thisAmerica is moving towards the land of "what do you me we?" "Your on your own." I believe stress is still the most understudied life shorten-er in the world and the aforesaid attitude just adds to it. Maybe this is why our life expectancy is shorter. We all live in a fit of panic wondering if we will end up the "have" side of things or will we be on the "have not". Every American deep down inside themselves know that the classes and the wealth are being divided up.
In my opinion America is divided by greed and we are not a nation of one mind and heart but a mob of individuals.
This can't be healthy.
Cancer screening do reduce cancer mortality, this is proven in breast cancer, colorectal cancer and recently for lung cancer in high risk populations. The issue of false positives remain,inducing bothering tests and costly procedures, but the approach of reaching a cost-efficiency decision by using concepts such as QALY cost has proven valid (QALY=Quality Adjusted Life Year). Regarding prostate cancer, a reduction in prostate ca mortality was observed in coincidence with the introduction of PSA. A recent ASCO abstract proposed an strategy based in a first PSA test around 45, if values are below a threshold, men will just need two additional tests at 50 and around 60, and this will be enough for more than 50% of men. The rest are the ones who deserve a closer follow-up. The US has the top medical technology in the world. Screening for other diseases lies in the family doctor side, but with an average 2600 patients for each general practitioner, it's estimated that 26 hours a day would be needed for a good preventive medicine. You must pass some of the workload to nursery, a UK study showed that endoscopies performed by nurses yield more findings and are linked to greater patient satisfaction than those done by doctors, but creating a half doctor curriculum will pose ethical and legal problems,as well as care quality ones. The field is moving, but currently, it's uncertain where it goes to.
Reply | Report Abuse | Link to thisConsult your family doctor, please!
Reply | Report Abuse | Link to thisOne of the significant problems causing high medical costs in the U.S. is lack of competition between insurance providers. Each state has a limited number of insurance companies operating with it, an some with only 3. There is no competition across state boundaries.
Reply | Report Abuse | Link to thisWhen we look at medical procedures not covered by insurance, say laser eye surgery or many cosmetic procedures, we see a significant decrease in cost as competition increases.
If the federal government would remove the barriers preventing competition, medical costs would decrease significantly. But this is not going to happen any time soon, as the our politicians are in the back pocket of the insurance companies.
Also, while the average French person may have better health care than the average American, they pay a lot in taxes to enjoy that, along with an ~17% lower standard of living.
There is a good proverb in Hindi language for healthy living.Eat half,doublethe drinking water,Triple physical exercises and increase four time laugh.
Reply | Report Abuse | Link to thisAs this comment demonstrates, we're never rational about public policy when we view it from our personal perspective. We want every benefit for ourselves even if it comes at the expense of others. Paying for ineffective procedures means that others are denied access to effective medical care. The cost of cancer screenings that produce no net benefit results in, for example, not paying for additional early diabetes screenings and treatment. By acquiescing to the demands of individuals, instead of following the science where it leads, we are sacrificing our public health.
Reply | Report Abuse | Link to thisWell with this current group in Washinton has done gutting the budget the US will slip further down in ranks of effective health care system. More isn't always best sometimes using what you have more effectively is best but those with health insurance don't give a damn until they are in my trap with a medical condition and no insurance then you see "real" health care system in the US. Because the US system is basically a fragmented system based on ability to pay or not to pay . Depending on where you fall is your outcome.
Reply | Report Abuse | Link to thisWell with this current group in Washinton has done gutting the budget the US will slip further down in ranks of effective health care system. More isn't always best sometimes using what you have more effectively is best but those with health insurance don't give a damn until they are in my trap with a medical condition and no insurance then you see "real" health care system in the US. Because the US system is basically a fragmented system based on ability to pay or not to pay . Depending on where you fall is your outcome.
Reply | Report Abuse | Link to thisChristine,
Reply | Report Abuse | Link to thisWhile I agree with most of your points on health care spending, I'm concerned about the message on cancer screening, especially when it comes from such a venerable source as SciAm.
My issues are two:
First, that not all cancer screening is the same: So when the press lumps breast, prostate, lung, colon and other screening tests together as one issue or "myth," readers or TV viewers may take away the imprecise or misleading message that all cancer screening is ineffective. The accuracy and risks of screening vary according to the method, and the potential benefits (in terms of potential life-years saved). For example, breast cancer is highly-treatable, affects tens of thousands of middle-aged women each year in the U.S. and, in invasive cases (the vast majority) is lethal if untreated. (Talk about myths, but that’s another story…)
Second, on breast cancer screening: the JNCI article cited (to support the "stat" of up to 50 percent false positives, above) dates to 2000, and looks back to records from 1983. BC screening, treatment and survival are all much, much better than they were back then. Most oncologists attribute the dramatic reduction in BC mortality since 1985 to a combination of improved surveillance and therapy for the disease (once found).
I am deeply concerned about women who are choose not to get breast cancer screening because of widespread press on the purported lack of benefit. Many of the reports, based in old data and info about other forms of malignancy, are enthusiastically heralded by journalists as "the real story." The truth is, perhaps, that subconsciously most of us prefer not to be screened for cancer; we're biased and, maybe, "like" results that screening is pointless, and so we celebrate those reports in the media, and the word spreads.
With respect,
Elaine
Outside those living in the US, does anyone think that the US health system is the best in the world? That didn't strike me as a myth so much as a fantasy...
Reply | Report Abuse | Link to thisI certainly agree with the author about myth #3 (access to health care) but there is one confusing thing.Look at the people in the country who take care of themselves: who eat sensibly, get exercise, and generally behave best in regards to their health. Its the middle class, the upper middle class and the rich. Its generally not the poor and the working class. In other words its the very people who because they have good health insurance through their employment or enough money themselves already do have good access to health care. And perhaps need it least.
Reply | Report Abuse | Link to thisYour argument under Myth #3 is arguing with itself. In case you didn't notice. Look at it closer. Throughout this article you are guilty of many classic fallacies of argumentative thought. Please brush up on your logic before proposing to call things "myths". Thank you so much. Have a nice day.
Reply | Report Abuse | Link to thisI believe that ultimately our health will be determined by what types of food we put into our bodies. Genetics certainly plays a role and while there are certain diseases that may be inevitable for some of us, ultimately the food we eat and the amount of exercise we get (Or don't get) will be the deciding factor. Western society seems hell bent on destroying itself with high fat, processed garbage that has been shown in study after study to have detrimental effects on the body. The U.S needs to start taking a proactive role in subsidizing fruits and vegetables instead of oil companies.
Reply | Report Abuse | Link to this