Cancer is one of the most devastating diseases facing humanity and it is the second leading cause of death in the US. To put things into perspective, 2023 is projected to see almost 2 million new cancer cases with over 500 thousand deaths.
With proactive cancer screening, cancer can be proactively detected and managed.
However, there is growing concern around how much is too much when it comes to cancer screening. While screenings can help detect cancer at an early stage, and potentially save lives, they might also cause needless worry and additional medical attention to those unlikely to benefit from it.
As cancer screenings become more readily available, we must be sure to weigh their anticipated benefits against the risks of overscreening, in order to best serve those whose health could actually improve with early diagnosis and treatment.
In the CareTalk episode, “Dr. Otis Brawley on Cancer Screening and Health Disparities”, hosts John Driscoll and David Williams are joined by globally-recognized cancer prevention expert, Dr. Otis Brawley, to investigate if cancer screenings are being misused in today's medical landscape.
Cancer Screening By The Numbers
Although cancer is not a one-size-fits-all diagnosis, there are several common cancer screening tests available to identify and diagnose cancer. Depending on age, gender and medical history, there are a number of cancer screening tests available. In addition to the standard tests such as mammograms, colonoscopies and Pap smears, physicians may also use CT scans and MRI scans in order to get a better look at any potential cancerous tumors.
When cancer screening is done properly it can lead to early-detection of cancerous growths which allows for more effective treatment measures. Screening can be Done through physical examinations and procedures such as biopsies, or through blood tests which analyze levels of cancer markers in order to detect cancer earlier on.
Overscreening for Cancer
Cancer has become a major health concern in the United States as well as throughout the world. As such, it is no surprise that cancer screenings have become an integral part of many doctor visits. This raises important questions about doctor’s tendencies to potentially overscreen for cancer. After all, cancer screenings can be expensive and invasive at times. Furthermore, the efficacy of routine cancer screenings is contested and debated amongst experts within the medical community.
Although cancer screening can potentially detect cancer at early stages and save lives, there is a debate over whether or not doctors should aggressively pursue cancer screening out of an abundance of caution; or if perhaps it makes more sense to take a more measured approach to identify those who could benefit from cancer screenings the most.
Certain guidelines have been put into place by The U.S. Preventive Services Task Force (USPSTF) to recommend when and who should receive cancer screenings. These guidelines have been subject to change over the years and while they are recommended, it is ultimately up to physicians to provide a course of treatment for their patients.
Potential Harms of Overscreening for Cancer
The purpose of cancer screening is to detect cancer in its early stages when it is most treatable. Unfortunately, this well-meaning strategy can sometimes lead to overscreening, which can cause more harm than good. Overscreening for cancer is very common among the older population and those with a limited life expectancy.
The greatest danger associated with overscreening is the possibility that individuals will receive false positive results that lead to needless anxiety and unwarranted medical procedures such as biopsies or surgeries. These procedures can result in complications such as side effects from medications, infections, and even death in rare cases.
Another potential danger is that individuals who would benefit from screening may not receive it because resources are being diverted towards those who are being screened unnecessarily. This can lead to delays in diagnosis and potentially life-threatening situations for those whose illnesses go undetected until it is too late. Additionally, overscreening puts strain on already limited budgets which means fewer people overall may receive necessary treatments due to financial constraints–even if they do manage to get correctly screened in time.
If you look at survival statistics or five year survival statistics, we do very well, but that's cause we screen a lot and we screen more than anyone else. If you look at mortality, that is our people not dying from cancer. We don't do as well". -Otis Brawley (CareTalk)
How Do We Safely Screen for Cancer?
We are now able to detect cancer in its early stages more accurately due to advances in medical technology, allowing for greater potential for successful treatment. It's important, however, that we use cancer screenings wisely and not succumb to overscreening. This means considering each individual risk assessment, taking into account factors like family cancer history, lifestyle habits and any other relevant information. Only then can health care providers determine the right series of cancer screenings and at what interval they should be carried out.
With careful thought around cancer screening processes, physicians can create tailored approaches that bring improvements in patient health outcomes while avoiding unnecessary costs and worry related to overscreening.
In the United States we don't spend much time thinking about risk behaviors that prevent cancer and risk behaviors that cause us to live longer. We spend an awful lot of time obsessed with screening, and I'm not against screening, it's just that there is wise use of screening and then there is overscreening. – Dr. Otis Brawley (CareTalk)
The Future of Screening Wisely
To conclude, it is clear that cancer screening is becoming more prevalent. We must be careful to not recognize it as a panacea and on its own is not a guarantee for increased survival rates. It’s critical to choose evidence-based lasting solutions for optimal health outcomes. Patients should be aware of the risks before taking part in any kind of cancer screening test, as well as their potential for overscreening if too many are taken too early in life. The best approach to dealing with cancer screening is to have a personalized healthcare plan based on the patient’s lifestyle, risk factors, and unique medical conditions.
Finally, we still have much work to do in properly managing cancer screening by the numbers by looking at policies or interventions that enable clinically beneficial readings while simultaneously guaranteeing cost savings. Ultimately, patients need to be educated on cancer screening options and decision support tools need to be provided so they can make informed decisions about their care.
CareTalk is the only healthcare podcast that tells it like it is. Join hosts John Driscoll (President U.S. Healthcare and EVP, Walgreens Boots Alliance) and David Williams (President, Health Business Group) as they provide an incisive, no B.S. view of the US healthcare industry.