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 comes down to personal preferences

Ira Nash, MD
Conditions
February 26, 2014
Share
Tweet
Share

I have been thinking a lot about cancer screening tests. It seems that there has been a constant stream of articles about screening in both the lay press and professional journals — as well as the inevitable stories in the lay press about the reports in professional journals — but this is more personal. I have had two recent experiences that I can’t get out of my mind.

A few weeks ago my wife and I went to Boston for a bittersweet reunion with a tight-knit group of my former medical school classmates. It was a bit of a last minute thing, triggered by a classmate’s business trip to Boston and our learning that one of “the gang” had advanced metastatic prostate cancer. Ironically, the one with prostate cancer is an oncologist. Amidst the merriment of our first hour together, between updates on our careers and stories of our kids, he addressed the “elephant in the room” by speaking frankly about his condition and prognosis. I won’t share details, but he did mention in passing that the problem with screening is that it “sometimes finds the small ones and sometimes misses the bad ones,” which I took to mean that whatever screening he had had, it failed to find his disease at a more treatable stage.

The comment probably stood out because of the conversation I had had with another doctor friend a week before. We were out to dinner with our wives, and I mentioned our upcoming trip and how a man our age was dealing with metastatic prostate cancer. I guess I must have said something about my own decision to not have a PSA done when I last saw my internist over the summer, to which he nearly erupted at the table. It was some variation on: “Are you nuts? You just told me that you have a friend with metastatic prostate cancer and you don’t want to get your PSA checked?” It is fair to say that the conversation got a bit strained after that. I tried to go with the “poor specificity of the test leading to unnecessary treatment” line of reasoning, but it was clear that there was an unbridgeable gap in our thinking on the subject, and I wanted to bury the conversation before it ruined everybody’s evening, so we dropped it and moved on to dessert.

I think these two related conversations have stuck with me for a few reasons.

First, I am sad about my old classmate, and of course his illness is an unwelcome reminder of my own mortality. Second, they remind me that it is incredibly difficult to separate the “anecdote” from the “evidence” in our clinical practice, and in our own lives. Third, thinking clearly about the risks and benefits of screening is hard: there is a lot of uncertainty in the evidence.  And finally, even if we could all agree on the facts, there would still be no single right answer about what to do.

Ultimately, decisions about screening, like so many other decisions about testing and treatment, come down to personal preferences — how we value certain states of health, how we feel about risk, and how we approach uncertainty.

Ira Nash is a cardiologist who blogs at Auscultation.

Prev

A thank you makes a family doctor's day

February 25, 2014 Kevin 4
…
Next

Doctors need to stop working 24/7

February 26, 2014 Kevin 3
…

Tagged as: Oncology/Hematology

Post navigation

< Previous Post
A thank you makes a family doctor's day
Next Post >
Doctors need to stop working 24/7

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by Ira Nash, MD

  • Let’s stop trying to change what doctors do

    Ira Nash, MD
  • Keeping up with the rapid developments in mobile health technology

    Ira Nash, MD
  • Not all doctors are physicians

    Ira Nash, MD

More in Conditions

  • Financing cancer or fighting it: the real cost of tobacco

    Dr. Bhavin P. Vadodariya
  • 5 cancer myths that could delay your diagnosis or treatment

    Joseph Alvarnas, MD
  • When bleeding disorders meet IVF: Navigating von Willebrand disease in fertility treatment

    Oluyemisi Famuyiwa, MD
  • What one diagnosis can change: the movement to make dining safer

    Lianne Mandelbaum, PT
  • How kindness in disguise is holding women back in academic medicine

    Sylk Sotto, EdD, MPS, MBA
  • Measles is back: Why vaccination is more vital than ever

    American College of Physicians
  • Most Popular

  • Past Week

    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education
    • Physician patriots: the forgotten founders who lit the torch of liberty

      Muhamad Aly Rifai, MD | Physician
    • The hidden cost of becoming a doctor: a South Asian perspective

      Momeina Aslam | Education
    • Why fixing health care’s data quality is crucial for AI success [PODCAST]

      Jay Anders, MD | Podcast
    • Gaslighting and professional licensing: a call for reform

      Donald J. Murphy, MD | Physician
    • Reclaiming trust in online health advice [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • How dismantling DEI endangers the future of medical care

      Shashank Madhu and Christian Tallo | Education
    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
  • Recent Posts

    • Gaslighting and professional licensing: a call for reform

      Donald J. Murphy, MD | Physician
    • How self-improving AI systems are redefining intelligence and what it means for health care

      Harvey Castro, MD, MBA | Tech
    • How blockchain could rescue nursing home patients from deadly miscommunication

      Adwait Chafale | Tech
    • When service doesn’t mean another certification

      Maureen Gibbons, MD | Physician
    • Financing cancer or fighting it: the real cost of tobacco

      Dr. Bhavin P. Vadodariya | Conditions
    • Why fixing health care’s data quality is crucial for AI success [PODCAST]

      Jay Anders, MD | Podcast

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 7 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

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why medical students are trading empathy for publications

      Vijay Rajput, MD | Education
    • Physician patriots: the forgotten founders who lit the torch of liberty

      Muhamad Aly Rifai, MD | Physician
    • The hidden cost of becoming a doctor: a South Asian perspective

      Momeina Aslam | Education
    • Why fixing health care’s data quality is crucial for AI success [PODCAST]

      Jay Anders, MD | Podcast
    • Gaslighting and professional licensing: a call for reform

      Donald J. Murphy, MD | Physician
    • Reclaiming trust in online health advice [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • How dismantling DEI endangers the future of medical care

      Shashank Madhu and Christian Tallo | Education
    • The broken health care system doesn’t have to break you

      Jessie Mahoney, MD | Physician
  • Recent Posts

    • Gaslighting and professional licensing: a call for reform

      Donald J. Murphy, MD | Physician
    • How self-improving AI systems are redefining intelligence and what it means for health care

      Harvey Castro, MD, MBA | Tech
    • How blockchain could rescue nursing home patients from deadly miscommunication

      Adwait Chafale | Tech
    • When service doesn’t mean another certification

      Maureen Gibbons, MD | Physician
    • Financing cancer or fighting it: the real cost of tobacco

      Dr. Bhavin P. Vadodariya | Conditions
    • Why fixing health care’s data quality is crucial for AI success [PODCAST]

      Jay Anders, MD | Podcast

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 comes down to personal preferences
7 comments

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

Loading Comments...