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The "cancer screening engine" rolls on – for better or worse

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Dr. Danielle Ofri, associate professor of medicine at New York University School of Medicine, raises important questions in her “Doctor’s Voice” column on a CNN blog. She writes:

“…the cancer-screening engine rolls on, oblivious to the fact that screening is a nuanced proposition that needs to be considered differently for different groups of patients.

As much as I hate to think about it, there are likely profit motives mixed in. There are all sorts of commercial entities that stand to gain with an aggressive indiscriminate screening message. Mammography is a big business. Imagine a high-tech product (iPhone or Android for example) that 25 percent of the population needs to purchase every single year. Somebody, somewhere, is raking in boatloads of money.

This is not to deride screening, or the important work that advocacy groups have done. As a primary care doctor, screening is one of the things I address with every patient at every visit. But the accuracy and specificity of these cancer screening tools are nowhere near as absolute as we would like–or as the public believes.

Unfortunately, conveying nuance and uncertainty is not a strong suit of the media, the public discourse, or doctors, for that matter. Everyone wants clear, definitive answers from a situation that will never be able to offer one.

I am an admirer of the American Cancer Society and the breast cancer awareness groups, but I get concerned when advocacy eclipses reality. As a result of years of advocacy work, most of the public currently believes that one of every eight women gathered in a room will get breast cancer. They are also under the impression that mammograms are perfect binary tests, sort of like light switches–they flick on to indicate cancer or flick off to indicate not.

Neither of these statements is true; the reality is far murkier. But complex, imperfect scientific facts rarely translate into sexy poster slogans.

Cancer screening is critically important in medicine. But there is a danger that the screening engine in our society is a one-track train, plowing forward, staying “on-message,” not to be bogged down with conflicting data, nuanced reasoning, or messy statistical analyses.”

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