Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Cancer screening is plagued by dissonance

Kevin Pho, MD
KevinMD
October 5, 2011
Share
Tweet
Share

Last year, the USPSTF was poised to meet regarding its prostate cancer screening guidelines.

According the Kenny Lin, a physician who was with the Task Force at the time, the meeting was cancelled for political reasons. He points us to a New York Times story on the dueling narratives of prostate cancer screening.

It’s a topic that often appears here on KevinMD.com, and it seems to have endless life.

On one side are the specialty-based recommendations that support PSA screening, backed by emotional anecdotes from prostate cancer survivors.

On the other are the evidence-based recommendations, like the ones from the USPSTF. As the Times story notes, this camp “makes a less emotionally satisfying argument: on balance, scientific studies do not support the claim that screening healthy men saves lives. Screening … can lead healthy men into a cascade of further testing and treatments that end up injuring or even killing them.”

This is a familiar dissonance that plagues the cancer screening debate.

Cancer screening is generally presented only in a positive light in mainstream media. “Early detection saves lives,” is what we often hear. But the reality is more nuanced, and unfortunately, isn’t prone to pat soundbites or inspirational ad campaigns.

Consider the following metaphor that illustrates this phenomenon, starkly told by David Newman, a director of clinical research at Mount Sinai School of Medicine in Manhattan:

“Imagine you are one of 100 men in a room,” [Newman] says. “Seventeen of you will be diagnosed with prostate cancer, and three are destined to die from it. But nobody knows which ones.” Now imagine there is a man wearing a white coat on the other side of the door. In his hand are 17 pills, one of which will save the life of one of the men with prostate cancer. “You’d probably want to invite him into the room to deliver the pill, wouldn’t you?” Newman says.

Statistics for the effects of P.S.A. testing are often represented this way — only in terms of possible benefit. But Newman says that to completely convey the P.S.A. screening story, you have to extend the metaphor. After handing out the pills, the man in the white coat randomly shoots one of the 17 men dead. Then he shoots 10 more in the groin, leaving them impotent or incontinent.

Newman pauses. “Now would you open that door?” He argues that the only way to measure any screening test or treatment accurately is to examine overall mortality. That means researchers must look not just at the number of deaths from the disease but also at the number of deaths caused by treatment.

The potential risks of cancer screening needs to be presented in the same light as its benefits. That includes the possibility of harm from increasingly invasive testing, along with complications from treatment.

Only when this complete picture is presented in the media can patients make a better informed decision.

ADVERTISEMENT

Kevin Pho is an internal medicine physician and on the Board of Contributors at USA Today.  He is founder and editor of KevinMD.com, also on Facebook, Twitter, Google+, and LinkedIn.

Prev

The use of a signing bonus as tool for physician recruitment

October 5, 2011 Kevin 0
…
Next

Calling yourself Doctor and what that now means

October 5, 2011 Kevin 11
…

Tagged as: Oncology/Hematology

Post navigation

< Previous Post
The use of a signing bonus as tool for physician recruitment
Next Post >
Calling yourself Doctor and what that now means

ADVERTISEMENT

More by Kevin Pho, MD

  • Surgeon General’s warning: the dark side of social media on children’s mental health

    Kevin Pho, MD
  • Unmasking wage disparity in health care: the truth behind the Elmhurst Hospital physician strike

    Kevin Pho, MD
  • Is FDA-approved Veozah a game-changer in menopause hot flash treatment?

    Kevin Pho, MD

More in KevinMD

  • The Spandex dilemma: Does size still matter?

    Janet L. Cray
  • Surgeon General’s warning: the dark side of social media on children’s mental health

    Kevin Pho, MD
  • Unmasking wage disparity in health care: the truth behind the Elmhurst Hospital physician strike

    Kevin Pho, MD
  • Is FDA-approved Veozah a game-changer in menopause hot flash treatment?

    Kevin Pho, MD
  • Remembering Heather Armstrong: the tragic loss of the “Queen of Mommy Bloggers” sparks a global conversation on mental health

    Kevin Pho, MD
  • Celebrating 2 million downloads of The Podcast by KevinMD!

    Kevin Pho, MD
  • Most Popular

  • Past Week

    • Health equity in Inland Southern California requires urgent action

      Vishruth Nagam | Policy
    • Could antibiotics beat heart disease where statins failed?

      Larry Kaskel, MD | Conditions
    • How restrictive opioid policies worsen the crisis

      Kayvan Haddadan, MD | Physician
    • Why palliative care is more than just end-of-life support

      Dr. Vishal Parackal | Conditions
    • How Filipino cultural values shape silence around mental health

      Victor Fu and Charmaigne Lopez | Education
    • How Japan and the U.S. can learn from each other to strengthen health care [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Why transgender health care needs urgent reform and inclusive practices

      Angela Rodriguez, MD | Conditions
    • COVID-19 was real: a doctor’s frontline account

      Randall S. Fong, MD | Conditions
    • Why primary care doctors are drowning in debt despite saving lives

      John Wei, MD | Physician
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Why pain doctors face unfair scrutiny and harsh penalties in California

      Kayvan Haddadan, MD | Physician
    • mRNA post vaccination syndrome: Is it real?

      Harry Oken, MD | Conditions
  • Recent Posts

    • How Japan and the U.S. can learn from each other to strengthen health care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Will longevity medicine put doctors out of work?

      Tomi Mitchell, MD | Physician
    • When doctors don’t talk: a silent failure in modern medicine

      Cesar Querimit, Jr. | Conditions
    • The many faces of physician grief

      Annia Raja, PhD | Conditions
    • Why the doctor-patient relationship needs a redesign

      Alexandra Novitsky, MD | Physician
    • Health equity in Inland Southern California requires urgent action

      Vishruth Nagam | Policy

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 8 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Health equity in Inland Southern California requires urgent action

      Vishruth Nagam | Policy
    • Could antibiotics beat heart disease where statins failed?

      Larry Kaskel, MD | Conditions
    • How restrictive opioid policies worsen the crisis

      Kayvan Haddadan, MD | Physician
    • Why palliative care is more than just end-of-life support

      Dr. Vishal Parackal | Conditions
    • How Filipino cultural values shape silence around mental health

      Victor Fu and Charmaigne Lopez | Education
    • How Japan and the U.S. can learn from each other to strengthen health care [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Why transgender health care needs urgent reform and inclusive practices

      Angela Rodriguez, MD | Conditions
    • COVID-19 was real: a doctor’s frontline account

      Randall S. Fong, MD | Conditions
    • Why primary care doctors are drowning in debt despite saving lives

      John Wei, MD | Physician
    • New student loan caps could shut low-income students out of medicine

      Tom Phan, MD | Physician
    • Why pain doctors face unfair scrutiny and harsh penalties in California

      Kayvan Haddadan, MD | Physician
    • mRNA post vaccination syndrome: Is it real?

      Harry Oken, MD | Conditions
  • Recent Posts

    • How Japan and the U.S. can learn from each other to strengthen health care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Will longevity medicine put doctors out of work?

      Tomi Mitchell, MD | Physician
    • When doctors don’t talk: a silent failure in modern medicine

      Cesar Querimit, Jr. | Conditions
    • The many faces of physician grief

      Annia Raja, PhD | Conditions
    • Why the doctor-patient relationship needs a redesign

      Alexandra Novitsky, MD | Physician
    • Health equity in Inland Southern California requires urgent action

      Vishruth Nagam | Policy

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Cancer screening is plagued by dissonance
8 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...