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Cancer Screening

Posted 7/19/2017

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  Most of us pay a lot of attention to recommended cancer screening: mammograms, colonoscopies, PAP smears, sometimes other tests in specific situations. Is this always wise? 

  There are always risks to any procedure, For mammograms, there are some concerns re radiation exposure and larger concerns about identified "somethings" that turn out, after biopsy, to be nothing. Most women who have had breast cancer would prefer these false positives and the accompanying anxiety to a missed diagnosis, but we might feel differently if something went really wrong with the biopsy.

  Jane Brody in The New York Times tackles this issue:

With Cancer Screening, Better Safe Than Sorry?
Personal Health

Doctors and medical organizations often advise that past a certain age, older adults can forgo various screening tests for cancer. But many patients, no matter how old or sick they may be, are reluctant to abandon tests they’ve long been told can be lifesaving.
To be sure, among my close circle of septuagenarian friends, none of us have stopped getting annual mammograms, even though I, having previously had breast cancer, am likely to be the only one among them for whom the potential benefit might conceivably outweigh the risks.
I’ve met people with no known risk for colorectal cancer who continue to get colonoscopies well past the age of established recommendations. Not to mention the countless men at low risk for prostate cancer who continue to get PSA tests, often at the suggestion of their doctors, when the best evidence says that for such men the test can result in more harm than good.
Few may realize that ill-advised screening tests come at a price, and not just a monetary one that adds many billions to the nation’s health care bill. Every screening test has a rate of false positive results – misleading indications of a possible cancer that requires additional, usually invasive, testing with its own rate of complications.
A new online survey of randomly selected participants clearly showed that women are more aware of the benefits of mammography screening than its harms. If, for example, a mammogram falsely detects a lesion — a not infrequent occurrence — the false-positive result may cause not only serious emotional distress but also lead to a surgical biopsy, which carries its own risks. And by the time they’ve had 10 mammograms, nearly half of women will experience a false-positive finding.

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