Another lesson about over-aggressive screening

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A New York Times editorial, “False Promises on Ovarian Cancer,” captures the latest chapter in the history of the too-much, too-soon enthusiasm for screening tests that often takes place – enthusiasm that is later overcome by the reality of evidence.  Excerpts:

“New evidence that women are more likely to be harmed than helped by screening tests for ovarian cancer is disturbing. The tests do nothing to prevent healthy women from dying from the usually fatal disease. Yet they often lead doctors to perform needless surgeries that cause serious complications in many patients.

Despite the expert advice against routine screening, a survey of 1,000 doctors published in February found that a third of them believed that screening was effective and many offered it to patients. Many patients request screening, believing that it can find the disease early enough to save lives. It is long past time for doctors and their patients to recognize that this assumption is wrong.”

Comments (6)

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Ken Leebow

September 12, 2012 at 9:48 am

When it comes to screening, we’ve got a long way to go before change takes place. NBC-Atlanta has a major PSA campaign called: Real Men Wear Gowns (promoting PSA screening).

http://www.11alive.com/life/community/realmen/default.aspx

Ken Leebow

September 12, 2012 at 9:48 am

When it comes to screening, we’ve got a long way to go before change takes place. NBC-Atlanta has a major PSA campaign called: Real Men Wear Gowns (promoting PSA screening).

http://www.11alive.com/life/community/realmen/default.aspx

Stuart Bennett

September 16, 2012 at 4:03 pm

The data for the study that was used as the basis for the recent conclusions was obtained about a decade ago. The PLCO study that was the primary information source for the recent USPSTF recommendations was completed in the early 2000’s. It has so many inconsistencies in follow up as well as questionable medical ethics re follow up and treatment to render it of questionable use. In addition, surgical procedures have advanced so in the current decade that the comparisons are worthless.
It is also noteworthy that the USPSTF recommendations seem to generally be released in the popular media-not refereed medical review and most physicians by survey reject the findings.
A new Standard of Care that not only honors but mandates the use of screening, even though not perfect, is required for these most deadly of cancers.
If the conclusions of a study don’t meet common sense, then ethical researchers are required to either investigate whether the study is flawed or the procedures accepted as constant within the study are flawed. In this case, I would argue that both factors influenced current conclusions.

    Gary Schwitzer

    September 18, 2012 at 7:13 am

    Stuart,

    Thanks for your note. You made your argument. In response, I would submit that screening should be an informed choice, not a mandate as you urge. Your line – “if the conclusions of a study don’t meet common sense” – demonstrates a classic gap between science and intuition, between what we believe/wish/hope and what we can prove.

    You are also incorrect in your statement that “USPSTF recommendations seem to generally be released in the popular media-not refereed medical review.” Check the Annals of Internal Medicine.

Stuart Bennett

September 16, 2012 at 4:03 pm

The data for the study that was used as the basis for the recent conclusions was obtained about a decade ago. The PLCO study that was the primary information source for the recent USPSTF recommendations was completed in the early 2000’s. It has so many inconsistencies in follow up as well as questionable medical ethics re follow up and treatment to render it of questionable use. In addition, surgical procedures have advanced so in the current decade that the comparisons are worthless.
It is also noteworthy that the USPSTF recommendations seem to generally be released in the popular media-not refereed medical review and most physicians by survey reject the findings.
A new Standard of Care that not only honors but mandates the use of screening, even though not perfect, is required for these most deadly of cancers.
If the conclusions of a study don’t meet common sense, then ethical researchers are required to either investigate whether the study is flawed or the procedures accepted as constant within the study are flawed. In this case, I would argue that both factors influenced current conclusions.

    Gary Schwitzer

    September 18, 2012 at 7:13 am

    Stuart,

    Thanks for your note. You made your argument. In response, I would submit that screening should be an informed choice, not a mandate as you urge. Your line – “if the conclusions of a study don’t meet common sense” – demonstrates a classic gap between science and intuition, between what we believe/wish/hope and what we can prove.

    You are also incorrect in your statement that “USPSTF recommendations seem to generally be released in the popular media-not refereed medical review.” Check the Annals of Internal Medicine.