November 23, 2012

THE HUMAN CONDITION, NOT AN ABERRATION:

Cancer Survivor or Victim of Overdiagnosis? (H. GILBERT WELCH, 11/22/12, NY Times)

So here is what we now know: the mortality benefit of mammography is much smaller, and the harm of overdiagnosis much larger, than has been previously recognized.

But to be honest, that general message has been around for more than a decade. Why isn't it getting more traction?

The reason is that no other medical test has been as aggressively promoted as mammograms -- efforts that have gone beyond persuasion to guilt and even coercion ("I can't be your doctor if you don't get one"). And proponents have used the most misleading screening statistic there is: survival rates. A recent Komen foundation campaign typifies the approach: "Early detection saves lives. The five-year survival rate for breast cancer when caught early is 98 percent. When it's not? It decreases to 23 percent."

Survival rates always go up with early diagnosis: people who get a diagnosis earlier in life will live longer with their diagnosis, even if it doesn't change their time of death by one iota. And diagnosing cancer in people whose "cancer" was never destined to kill them will inflate survival rates -- even if the number of deaths stays exactly the same. In short, tell everyone they have cancer, and survival will skyrocket.

Indeed, if we had a massive public health campaign to tell everyone that cancer is a natural part of being human it might destigmatize the condition enough that folks would calm down and deal with it rationally. Posted by at November 23, 2012 4:43 AM
  
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