CANCER SCREENING FOR THIS CANCER IS DANGEROUS?

Before we go any further, we need to agree that there is always, always a risk benefit with any type of cancer screening.  Some screenings, like mammography, actually become a risk for cancer in and of itself due to the radiation.  Colonoscopy carries a risk of perforation during the procedure or a bad reaction to the anesthesia.  Some screenings find cancer too early when the body might have potentially resolved the cancer itself (breast cancer) or if the cancer was slow growing and likely would not have been the cause of death in a patient (prostate). 

All screenings carry the risk of false negatives (cancer is actually present, but not found by the screening).  They also carry the risk of false positives (there is no cancer actually present, but the screening test suggest there is).  The false positives not only produce high levels of anxiety in patients, but they all too often lead to procedures that were not necessary.

This particular study looks at the use of intravaginal ultrasound and CA-125 screening for ovarian cancer.  Ovarian cancer can be a nasty cancer if it is not found early enough, and the actual procedural risks of the two screenings mentioned are negligable.  However, the risk of false positives carries significant risk for harm. 

Out of 78,000 women screened with CA-125 and ultrasound vs normal care (no screening), the screening group, there was negligible difference between the groups (in other words, the screening had no effect at all on the risk of dying from ovarian cancer).  Of grave concern, however, 3285 women were given initial false positives.  1080 of these women underwent surgical follow up (remember that they did NOT have cancer).  163 women experienced a severe complication as a result of the unneeded surgery.

The bottom line, as always, is that our society is very, very, almost entirely dependent on, screening for cancer.  This and treatment all always the emphasis, and yet the screenings, despite societal belief, frequently do not alter the risk of dying of the cancer looked for.  This particular study led to a very large number of surgeries, not the mention the psychological impact.

The answer always has and always will lie with prevention.  There are no inherent risks to positive lifestyle changes (although I did suffer 2nd-3rd degree burns on my forearm from lentils some time ago…) and a massive impact on cancer risk.  Going through life relying on screening alone in lieu of lifestyle changes is just plain wishful thinking.  It will not extend your life or lower your risk of dying of this dreadful disease.  Lifestyle WILL.

http://jama.ama-assn.org/content/305/22/2295.abstract

For more than a decade, Dr. Bogash has stayed current with the medical literature as it relates to physiology, disease prevention and disease management. He uses his knowledge to educate patients, the community and cyberspace on the best way to avoid and / or manage chronic diseases using lifestyle and targeted supplementation.







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3 thoughts on “CANCER SCREENING FOR THIS CANCER IS DANGEROUS?

  1. Did you notice that no healthy subjects were accepted into study…and regular medical care was whatever local docs provided. I’m with you on healthy life style, but with a potential for genetically based cancer, I have had a number of screenings and appreciate the relief of negative outcome. Those in the study with a false positive was determined (how??) needed a different followup than “regular medical care”. I got this “good care” from Dr. Gaby’s office 30 years ago and still follow the supplement regimen advised. CA 125 is still negative.

  2. Yes–noticed that “regular medical care” was a little vague. But this was meant to be everything else except the screenings. The problem is that, in general (and yes, I’m generalizing here…), screenings are used in lieu of healthy lifestyle changes. When we do that, the benefits of the screenings go down and do little to change the long term outcome.

  3. I think some people have even come to view screenings as prevention, in lieu of making necessary behavioral changes.

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