Screening (from a 30,000 foot view)

When you go through the screening systems at our national airports, there are often videos that describe the process, reminding you to take any liquids out of your suitcase and so forth. I think it is time for cancer centers (and others) to do the same thing at their annual screening events for breast, prostate and other cancers. I have no problem with participating in screening events if the participants are fully informed about the benefits, risks, and the controversies surrounding screening for prostate cancer. However without such information, I fear that most men simply open Pandora’s box without really knowing what they are getting into. Does a 75 year old man realize that his chances of dying from prostate cancer are tiny compared to the other lurking causes of death? Does a 60 year old man understand that a Gleason 6 cancer can be followed safely with active surveillance, but that it will require “life long” repetitive biopsies? The NEJM article on this issue this week is worth everyone reading. Marketing should not be what medicine is about.


Filed under General Prostate Cancer Issues

11 responses to “Screening (from a 30,000 foot view)

  1. Richard Stanton

    The issue is not whether a 75 year old man or a 60 year old man realizes what the death risk is for protate cancer or knows that active surveillance might be an option instead of immediate treatment. The issue is why so many doctors do not inform men of these facts? A man cannot be treated unless prescribed by a doctor. The test is not to blame; it’s the misuse of the test results by doctors that has lead to unnecessary treatment. I see you are in agreement with this conclusion – how can we educate your brethren on these points (or is the profit motive too much to overcome)?

    • There is no doubt a profit motive, but I think the real issue lies with a) the general state of passivity of most men regarding their health; and b) the time required to fully explain the dilemma surrounding prostate cancer screening: saving a few lives at the expense of overdiagnosing and overtreating a lot of men. I would estimate from personal experience (I tried this at a screening clinic) that it takes about 15-30 minutes to give a “fair and balanced” presentation of the situation and answer questions. It is much easier to hand men a 10 page form, ask them to initial each page (along with the other 10 pages you get every time you visit the doctor), and call this “informed consent”. On the issue of passivity, many men after hearing my “lecture” are more interested in what time the Bronco game starts !

      • Richard Stanton

        LOL! There’s blame to go around on both sides then! But under the apathetic patient theory, if, for example, the doctor recommends active surveillance, the Boncos fan presumably will go along with it – because there will be more time to watch the game. Thanks.

  2. Joe Blue

    “The intent should be neither to persuade people to undergo screening nor to dissuade them from doing so, but to increase the awareness of screening’s benefits and harms so as to encourage informed personal decisions.”

    Absolutely. Yes on information, yes on personal decisions. Thanks.

  3. Gezer

    Well said. I like the video idea, but it needs to be personalized…

  4. Joe Blue

    The “time required” problem is the profit motive in disguise.

    Why isn’t there a web-site that gives the fair and balanced view? That gives patients the information they need without costing physicians time and hence money.

    And no need to worry about passivity – that’s a personal choice.

    What about the web site?

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