"Cancer by the Numbers" by John Allen Paulos | Project Syndicate - 0 views
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The USPSTF recently issued an even sharper warning about the prostate-specific antigen test for prostate cancer, after concluding that the test’s harms outweigh its benefits. Chest X-rays for lung cancer and Pap tests for cervical cancer have received similar, albeit less definitive, criticism.
CommentsView/Create comment on this paragraphThe next step in the reevaluation of cancer screening was taken last year, when researchers at the Dartmouth Institute for Health Policy announced that the costs of screening for breast cancer were often minimized, and that the benefits were much exaggerated. Indeed, even a mammogram (almost 40 million are given annually in the US) that detects a cancer does not necessarily save a life.
CommentsView/Create comment on this paragraphThe Dartmouth researchers found that, of the estimated 138,000 breast cancers detected annually in the US, the test did not help 120,000-134,000 of the afflicted women. The cancers either were growing so slowly that they did not pose a problem, or they would have been treated successfully if discovered clinically later (or they were so aggressive that little could be done).
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It is difficult to communicate medical risk to a large audience, especially when official recommendations conflict with emotional narratives. That is why, when the United States Preventive Services Task Force (USPSTF) in 2009 presented its guidelines for breast cancer screening, which recommended against routine screenings for asymptomatic women in their 40's and biennial, rather than annual, mammograms for women over 50, the public responded with confused fury.
Illustration by Paul Lachine
CommentsThe key to understanding this response is to be found in the nebulous zone between mathematics and psychology. People's discomfort with the findings stemmed largely from faulty intuition: if earlier and more frequent screening increases the likelihood of detecting a possibly fatal cancer, then more screening is always desirable. If more screening can detect breast cancer in asymptomatic women in their 40's, wouldn't it also detect cancer in women in their 30's? And, if so, why not, reductio ad absurdum, begin monthly mammograms at age 15?



