By Dr. Seymour Handler - Guest blogger
Retired Pathologist, North Memorial Medical Center, Minneapolis
A long-standing recommendation by many prestigious health entities is that people should have a health evaluation examination and cancer screenings at regular intervals, ostensibly to detect diseases earlier than would occur when the disease becomes symptomatic, thereby making a cure more likely.
There has been relatively little effort to refute this gospel, although a few brave souls have dared to question the concept. Screening "makes sense," and therefore it is popular with physicians, the media, government and patients.
Unfortunately, what "makes sense" must add up to the painful scrutiny of appropriate studies, particularly random clinical trials (RCTs). These trials are time-consuming and expensive. It is because RCTs are so difficult to perform that so many diagnostic and therapeutic approaches bypass them, and instead operate on the often mistaken idea that, because they "make sense," unproven technology becomes everyday practice.
Every patient who has had successful removal of a colon cancer detected initially by fecal occult blood testing is absolutely convinced that the successful outcome was caused by the screening test.
The possibility that an equally good result might have ensued without the screening, when the cancer became symptomatic, is not acceptable to the patient. But did you know that 50 percent of colon cancers are cured whether detected by screening or when symptomatic.
Cost-effective preventive medicine must be evidence-based. Screening programs and regular health evaluations should be studied for efficacy, prior to implementation into everyday practice.
Guidelines for screening should take into account the patient's age, health status, the natural history of the screened disease, and the adverse effects of false positive screening results.
The public needs to realize that the benefits of screening often decline based on the age of the patient. In many cases the patient "dies with the disease, rather than of it."
Dr. Seymour Handler practiced pathology at North Memorial Medical Center in Minneapolis for nearly four decades. Prior to retirement in 2000, he held an academic appointment in the Department of Laboratory Medicine and Pathology at the University of Minnesota Medical School.
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