Cancer prevention: ‘More testing is not always better’ – The Globe and Mail

More on the recent recommendations on reduced cancer screening. While the article ends up, sensibly enough, for informed patient doctor discussions on the benefits and risks of screening, the main point is:

The evidence that led to the changes is extensive. It shows that individuals are much more likely to receive a false-positive result, undergo unnecessary procedures such as biopsies or radiation, or experience life-altering side effects under the old screening programs than they are to have their life saved from cancer. Routine prostate screening, for instance, leads to a small reduction, or no noticeable reduction, in cancer deaths over a 10-year period, according to the U.S. Preventative Services Task Force, which crafted the new guidelines, while the risk of urinary incontinence, erectile dysfunction or other complications due to unnecessary testing and treatment are much higher. The PSA test leads many men to undergo treatment for cancer that never would have become symptomatic.

Cancer prevention: ‘More testing is not always better’ – The Globe and Mail.


2 thoughts on “Cancer prevention: ‘More testing is not always better’ – The Globe and Mail

  1. Sorry but I disagree with the basic premise of this article.

    “It’s nuanced advice that has been formed after rigorous study of routine breast, cervical and prostate-cancer screening programs found that for some people the risks far outweigh the potential benefits.”

    I would rather assume the risks of having early results than not knowing, having wasted precious time, and without the benefit of doing a double check and considering treatment options. So what of false positives? Duplicate analyses and quality control should be part of any good medical testing practices like in other branches of science. The worry and anxiety it may lead to are manageable no?.

    The weasel words in the article’s opening statement are “some people”. Of course! But how many, what fraction of the population, how many subjects were considered. I find this to be sloppy discourse and bad science journalism.

    I had very high PSA levels going back 10 years ago. My dad had prostrate cancer but died of another cause. Knowing my risk factors, my urologist, did the right thing. He double checked by means of independent testing. After three positive biopsies, he concluded that I had benign hyperplasia of the prostrate. As a precaution was prescribed Avodart, which controls the mass of the prostrate and reportedly delays the occurrence of cancer. The point being that early action was taken. That works for me!

    Now, if only there was an early screening test for non Hodgkin lymphoma, I might be in a better place today. In March 2012, I was diagnosed with stage IV DLBCL.

    Don D

    p.s. Hey Andrew keep up the good work!

    • Hi Don,

      Nice to hear from you and thanks for sharing your comments. My sense from all the various articles I have read on the various screening recommendations is that routine screening has its own risks of over-treatment, likely to increase as our tests become more sophisticated over time. I think your urologist did the right thing: he took account of family history and did the necessary double checking and rechecking. My understanding of screening recommendations is that they pertain to people without family history.

      But the key point for me in all of this is to have an intelligent and informed discussion with one’s doctor on whether screening is recommended based on family history and, should something show up, do the necessary rechecking before embarking on treatment, and be fully aware of the risks of doing nothing versus treatment. In my case of MCL, or course, it was death or a chance at life so it was not too much of a choice in the end

      Cheers and thanks for the discussion.


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