Showing posts with label Peter Bach. Show all posts
Showing posts with label Peter Bach. Show all posts

Friday, February 28, 2014

Overediagnosis and Mitigated Overdiagnosis: Ongoing problems with Breast and Lung Cancer Screening

I got to thinking about cancer screening (again) in the last week after reading in BMJ about the Canadian National Breast Screening Study (CNBSS).  That article piqued my interest because I immediately recalled the brouhaha that ensued after the U.S. Preventative Services Task Force (USPSTF) recommended that women not get mammograms until  age 50 rather than age 40.  That uproar was similar to the outcry by urologists when the USPSTF recommended against screening for prostate cancer with PSA testing.  Meanwhile, changes in the cholesterol guidelines have incited intellectual swashbuckling among experts in that field.  Without getting into the details, observers of these events might generate the following hypotheses:
  1. People are comfortable with the status quo and uncomfortable with change
  2. People get emotionally connected to good causes and this makes the truth blurry, or invisible.  After you've participated in the Race for the Cure, it's hard to swallow the possibility that the linchpin of the Race might not be as useful as we thought; and is no longer recommended for a whole swath of women. 
  3. People are terrified of cancer
  4. Screening costs money.  Somebody pockets that money.  Urologists and radiologists and gastroenterologists LOVE screening programs.  So do Porche dealers.