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Medical radiation screening – too lucrative to manage sensibly?

Screen test FT By Dr. Margaret McCartney  November 9 2009 News from the US, I can scarcely believe it: The New York Times reports that the American Cancer Society now accepts that screening for breast and prostate cancer is not only inefficient, but frequently inaccurate and alarmist.
It has realised that such programmes – designed to detect cancer early – can do damage too, because they often detect cancers or pseudocancers that were never going to maim or kill.That is the bit I can believe. After all, these are evidence-based observations, and none is particularly new. A recent paper in the Journal of the American Medical Association (Jama) also highlighted the weaknesses of screening. What I have difficulty with is that paper’s conclusion: “To reduce morbidity and mortality from prostate cancer and breast cancer, new approaches for screening, early detection, and prevention for both diseases should be considered.” The problem with screening and even early detection is that because these two elements sound useful, we have great difficulty in believing it when the evidence tells us they are not…………….
screening comes at significant cost, including overdiagnosis and overtreatment. The complications of therapy are likely to get worse as the population ages. Not only that, but treatments for relatively indolent disease may in themselves do harm. Is screening for these disorders so ineffective, relative to its complications, that we should rethink it entirely? Not only has the rate of diagnosed aggressive breast cancers failed to decline, but ductal carcinoma in situ now accounts for up to 30 per cent of breast cancer diagnoses at screening. Before widespread screening, this potential pre-cancer was rarely diagnosed. Now it is treated as though it were cancer, but the actual progress of this lesion is far from certain and it does not always do harm.
Why isn’t there more openness about the problems of screening? Is it because we have created a screening industry, both in and outside the NHS?

FT.com / weekend columnists / Margaret McCartney – Screen test

November 9, 2009 - Posted by | 1, health, UK | , , ,

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