Screen everybody for pancreatic cancer? Where is the discussion of evidence, harms?

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Continuing this week’s spontaneous theme (we didn’t make the claims and write the stories) of runaway enthusiasm for various screening tests by some researchers and journalists….

The HealthDay news service last week reported on a study, published in the Oct. 28 issue of the journal Nature, that they say “provides new insight into the genetics of pancreatic cancer.”

In the story, they let one of the researchers get away with saying – almost unchallenged –

“What’s important about this study is that it’s objective data in support of why everyone should be screened for pancreatic cancer.”

Mind you, this was a study that looked at tissue from just seven patients.

The story continued with its breathless enthusiasm for the pancreatic cancer screening idea:

“In the future, new imaging techniques and blood tests will offer hope for early detection, the study noted. And just as people have a colonoscopy when they turn 50, “perhaps they should have an endoscopy of their upper gastrointestinal organs that includes an ultrasound of the pancreas,” said (the researcher).”

The very end of the story included some skepticism from Dr. Len Lichtenfeld of the American Cancer Society:

“Lichtenfeld, however, says it’s “a bit optimistic” to suggest that current technologies, such as ultrasound, can diagnose pancreatic cancer early enough to make a difference. Another cancer with virtually no symptoms in its earlier stages — ovarian cancer — is not often found with ultrasound, he noted.”

But nowhere in the story was there a discussion of the harms of screening. All screening tests cause harm. This researchers’ suggestion was that all 50 year olds might have endoscopies. Just last week a new study reported that 1 in 100 people who had colonoscopy or upper-gastrointestinal endoscopy had complications serious enough to send them to the emergency room — a much higher rate than expected.

But in our screening enthusiasm – screen everybody at all costs – over and over again we tend to trumpet the potential benefits and minimize or ignore the potential harms and overall, fail to evaluate the quality of the evidence.

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Susan Fitzgerald

November 8, 2010 at 10:50 am

Thank you so much for calling out all these screening issues. The definition of “preventive” is now so associated with “medicine” that we’re being led to believe theres’s nothing you can do preventively that doesn’t involve medical goods or services.
The public likes to believe that all investigational research is utterly unbiased and therefore valid and influenced by the best of motives.
Here’s one scan that could do a world of good: take a look at the current Atlantic Monthly article, “Lies, Damned Lies and Medical Statistics.” http://www.theatlantic.com/magazine/print/2010/11/lies-damned-lies-and-medical-science/8269
It’ll kill any thought that research is in the main useful, accurate, or correctly understood and deployed, let alone reported.
Keep up the great work.