Health News Review

It’s a new twist on “having skin in the game.”

During today’s USA World Cup match, Mount Sinai Hospital in New York City tweeted:

Ok to cheer for the red, white and blue.

But with these “free skin cancer screenings,” I wonder if people were told that:

  • The US Preventive Services Task Force concludesthat the current evidence is insufficient to assess the balance of benefits and harms of using a whole-body skin examination by a primary care clinician or patient skin self-examination for the early detection of cutaneous melanoma, basal cell cancer, or squamous cell skin cancer in the adult general population.”
  • The Task Force states: The majority of suspected melanoma lesions detected during screening programs are not actually melanoma, and these false-positive results lead to biopsies and possibly unnecessary treatment. In addition to detecting false-positive lesions, screening identifies nonmelanoma skin cancers and thin melanomas; some of these lesions may have little potential for malignant spread and mortality. Surgical or other treatment of these lesions could result in overtreatment.

That would start to approach informed consent.

What’s your bet that this kind of stuff was discussed?

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Comments

Stewart Ellenberg posted on July 14, 2014 at 3:31 pm

What are your thoughts about having these screenings performed by board certified dermatologists? We recently did this at work and one employee had a melanoma discovered that day. It was something that he knew was there but he thought that it was nothing to worry about. Surgery was performed the next day on him and he believes that the screening may have saved his life. Numerous other people had basal cell cancers discovered and they were referred to their own dermatologist for follw up care.

Reply

    Gary Schwitzer posted on July 14, 2014 at 3:53 pm

    Stewart,

    Thanks for your note.

    No matter who does the screening, it doesn’t change the evidence, or the lack of evidence.

    Read what the US Preventive Services Task Force wrote. There are harms that occur from screening. We tend to only focus on the benefits. And they state that the balance of harms and benefits is uncertain due to the uncertainty of the evidence.

    Regarding the person who had the screening at work, I have two thoughts:

    1. If he knew something was there, we shouldn’t be calling this a screening test. Screening is looking for problems in otherwise apparently healthy people. This guy already knew he had a problem. He was just in denial.

    2. The plural of anecdote is not data. Yes, you’ll catch some cancers. But, yes, you’ll also put some people through false-positive results leading to biopsies and possibly unnecessary treatment. So, yes, you’ll also find stuff you didn’t really need to or want to know about. And that can lead to overtreatment. And that’s a harm.

    People need to be educated about the tradeoffs – both the potential benefits AND the potential harms. Then they can make a more informed choice.

    Reply

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