Screening crusaders who simply get it wrong


New media writer Jeff Jarvis, recently diagnosed and treated for prostate cancer, is writing about screening again:

"I say, thank god science for screening."

He's entitled to his opinion.

He is not entitled to his own personal version of the facts. He writes:

"There is a growing rumble about curtailing screening."

No. That is simply wrong. There is no move for "curtailing" screening. There are many, however, who are calling for better and more balanced presentation of the potential harms - not just the potential benefits - of such screening.

That is not curtailing. It is not rationing. Nothing would be taken away from anyone.

This kind of talk is classic fear-mongering. When Dr. Otis Brawley of the Cancer Society spoke up about the limitations of screening last week, I read where one pro-screening crusader commented that this is "another sign of Obama health care."

Wow. But I've often thought that the screening camps are as polarized as political camps. It's just that the screening camps tend to be these:

1. Those who think that EVERYONE should be screened.
2. Those who wouldn't promote screening nor deny it to anyone, but, rather, would better inform men.

Jarvis concludes his recent column:

"As a matter of statistics and odds, I know screening results in treatment that adds to costs. But it also saves lives - no matter whether we know precisely how many. I believe screening saved my life and I chose not to have been proven right by waiting.

So get your screenings, folks, get 'em while they last."

No one is taking anything away. It's not a matter of "get 'em while they last." That's absurd.


Thank you Mr. Schwitzer, for your calm and reasoned remarks on cancer screening. Screening can appear to be a waste of time and money - but not to cancer patients. Here is our family's experience.

My husband, Steve Bergener, is being treated for esophageal cancer at MD Anderson cancer center in Houston, Texas. I say "being treated" because he is cancer-free and has been going for followup tests since his esophagectomy in February 2009. Steve's cancer was diagnosed when he had his regular endoscopy. Our GI doctor recommended the test every two years because Steve had GERD. Endoscopy is expensive, a hassle, and does have slight risks. Our GI told us that the cost-effectiveness of routinely using this test is being debated by his field. But our doctor still recommends it for patients like Steve. Each individual is a statistic of one, he told us, so each patient must decide what to do.

Without this test, the cancer would not have been discovered until it had progessed significantly. As it was, we were lucky to find it early. Steve and I both believe our GI, the test, and excellent treatment at MD Anderson saved his life. I am very grateful to all involved. Steve's odds of cure are good (60 to 80 percent). The odds would have been less than ten percent if the cancer was discovered when symptoms appeared.

How to screen, when to screen, and when and how to treat cancers once diagnosed will be debated and studied for many years. Because in this country we can all participate in health care policy development, I am confident that screening decisions will remain up to patients and doctors. It is up to all of us to make sure it does.


Thanks for your note.

But what your husband did was not screening.

Screening is looking for disease in those who have no signs of problems.

As you described it, your husband was already having regular endoscopies because he had GERD.

So his cancer wasn't found by screening, but by following testing of a known condition.

This is an important distinction that is lost on many people.

About this Entry

This page contains a single entry by Gary Schwitzer published on October 28, 2009 7:00 AM.

Buffalo's talking about prostate screening was the previous entry in this blog.

Something doesn't feel right about FDA - WebMD partnership is the next entry in this blog.

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