Consumer Reports cover story: Cancer tests you need – and those you don’t

The cover story of the March edition of Consumer Reports is “The cancer tests you need – and those you don’t.”  You need a subscription to access the full content, but here’s a glimpse of what’s inside.

The headings are:

Here are those eight, from CR:

  • Bladder cancer  – test to check for blood or cancer cells in the urine.
  • Lung cancer – low-dose CT scan
  • Oral cancer – visual exam of the mouth by a dentist or other health-care provider
  • Skin cancer – visual exam of your skin by a physician looking especially for signs of melanoma
  • Prostate cancer – prostate-specific (PSA) blood test
  • Ovarian cancer – transvaginal ultrasound or the CA-125 blood test
  • Pancreatic cancer – genetic tests or imaging tests of the abdomen
  • Testicular cancer – physical exam of a man’s testicles

From the article:

“The message that you have nothing to lose and everything to gain from being screened for cancer—that is, to be tested for a cancer before you have any symptoms of it—simply isn’t true.

“The medical and public-health community has systematically exaggerated the benefits of screening for years and downplayed the harms,” says H. Gilbert Welch, M.D., a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice in Lebanon, N.H.

In a recent article in the New England Journal of Medicine, Welch found that the number of early breast-cancer cases had shot up since mammography became common three decades ago but that advanced cancer cases hadn’t declined much. Welch estimated that in 2008 more than 70,000 women 40 and older were found to have small, non­aggressive cancers that were treated even though they probably wouldn’t be life-threatening.

Such treatment, including radiation or the surgical removal of all or part of the breast, can cause serious complications, such as bone loss and menopause-like symptoms. And even when it doesn’t lead to treatment, screening can lead to unnecessary biopsies, which can cause anxiety and pose a small risk of infection.

“When it comes to screening, most people see only the positives,” says Otis Brawley, M.D., chief medical officer of the American Cancer Society. “They don’t just underestimate the negatives, they don’t even know they exist.”

5 questions to ask

Before undergoing any cancer screening, ask your doctor:

1. If the test results are positive, will it save my life?

2. Am I at higher risk for cancer than the average person, and if so, why?

3. How often does the test give false alarms? How often does it provide falsely reassuring results?

4. Are any other tests just as good?

5. If the results are positive, what’s next?


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