Challenging the conventional wisdom that early detection must always save lives

In a New York Times blog piece on “The Shortfalls of Early Cancer Detection,” Dr. Barron Lerner captures the “long and impassioned history among cancer screening advocates that early detection must always save lives. But as science has taught us, that’s not always the case.”

This is an important article to read.

Lerner writes:

“…research emerged that questioned the cancer society’s original assumption that cancer was a local disease that spread in a gradual and orderly fashion. Scientists had found cancer cells in the blood of patients with seemingly tiny, localized cancers, suggesting that cancer cells could spread silently early in the course of disease. In that case, so-called early detection might not really be early, or of much value.

This was not a message, however, that people wanted to hear. The ‘war on cancer,’ which was formally declared in the 1970s, was predicated on the optimistic message of early detection and treatment. How could it be reconciled with the idea that nothing could be done to better one’s chances of survival?

Patients whose cancers had been detected by new screening strategies like mammograms and Pap smears, and then cured, were particularly upset. To many, the notion that their proactive efforts had not saved their lives — that they would have done just as well if their cancers had been picked up later — defied sense.”

I have seen and read this reaction and, while it is understandable, it demonstrates the challenge in educating the public about evidence.

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Dr Joe

October 17, 2011 at 10:31 pm

It is good that this information is starting to get out. Doctors also need support as it you are less likely to be sued for “doing something” as against “not doing something”. This is regardless of whether that “something” is helpful