Here's an article in the New York Times about people who are diagnosed with cancer in midlife, and the trials they face after beating cancer. Many of them are impoverished, even driven into bankruptcy, by the high cost of their treatment and medications. Many of them survive cancer only to find out that doing so has made them unemployable. Employers, acting in their own rational self-interest, will not hire someone who has had cancer, since they are afraid that doing so will drive up their health insurance costs.
But hey, it's better than being dead, right?
Now here comes the astounding part: "“Cancer used to be a disease that occurred after you retired, because that’s when you were diagnosed,” said Cathy J. Bradley, a health economist at Virginia Commonwealth University Massey Cancer Center who has studied employment among cancer patients. “Now patients are getting that diagnosis early on, which is a good thing. . . .But I don’t think they or their employers are prepared for the tradeoff, which is that someone may be out of work for a long time.”"
In other words: these people had their lives ruined by being diagnosed with "cancers" which, according to the article, never would have bothered them until they were at the end of their lives anyway!
There is no evidence that screening asymptomatic people for cancer helps people to live longer. The whole idea of screening for cancer was based on the hope -- that's all it ever was, a hope -- that there were cancers that were so deadly that by the time symptoms appeared, it was too late to do anything about them, BUT, which if detected sooner, could be successfully treated. There is no evidence that such cancers even exist. What we do know is that, if they do exist, they must be so rare as not to make a difference in survival rates. What screening for cancer does do is detect the presence of a lot of tiny "cancers" which never would have harmed the patient. And, as the article makes clear, a diagnosis of cancer can ruin your life.
Of course, I don’t expect anyone to take my word for any of this. But here are two books by H. Gilbert Welch, M.D., M.P.H, and Nortin M. Hadler, M.D. that ought to give anyone pause. To summarize their conclusions: screening for prostate cancer reduces mortality due to prostate cancer but not overall mortality; screening for breast cancer reduces neither mortality due to breast cancer nor overall mortality; and screening smokers for lung cancer (talk about rearranging deck chairs on the Titanic) actually resulted in greater mortality. There is no data on the worth of screening for other kinds of cancers, because nobody has done the studies.
So is screening for cancer a giant con job?
Photo via Wikimedia Commons
Update 19 March 2009: since I posted this, two large and well-designed clinical trials underscoring the futility of screening asymptomatic patients for prostate cancer have been published in the online version of the New England Journal of Medicine. They are:
Andriole et al.: Mortality Results from a Randomized Prostate-Cancer Screening Trial
Schroder et al.: Screening and Prostate-Cancer Mortality in a Randomized European Study