Limited benefits of cancer screening tools not known to general public

An eye-opening article appeared in this week's New York Times about cancer screening — specifically that the benefit is relatively small. If the social networking/Web 2.0 sites are any measure of the public impression, many lay folks were quite surprised by this.

I feel like I have been saying something along these lines since residency where I was taught about the relatively small benefit (or, more precisely, the number needed to screen for one person to benefit) for most cancer screening tools. But apparently that message did not get filtered to the general public.

I know I have heard many times from patients, family members and concerned friends, "How can I (she) have breast cancer? I (She) had all the mammograms the doctor recommended!" So you launch into conversations about lead time bias, prevalence and incidence, and the negative predictive value of a test, and it becomes one big confusing mess of a conversation.

But Dr. Otis Brawley is able to summarize things much more succinctly in the article, saying, “Cancer is a complicated disease ...We shouldn’t try to fight it with simplistic messages.”

The conversation prior to a screening test is long, complicated and nuanced, and I doubt most providers have time for it, nor do patients understand the limitations of the test at hand. I am glad this is getting some national press. And lest anyone misunderstand and think the American Cancer Society is stating people shouldn't be getting mammograms anymore, the ACS issued a clarification to the New York Times story. Perhaps the rallying cry from cancer screening advocates shouldn't be "Get your mammograms!" or "Check your PSA!" but that we need better screening tests for these very common cancers.