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In Push for Cancer Screening, Limited Benefits PDF Print E-mail
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Thursday, 16 July 2009 00:00
"Don't forget to check your neck," says an advertising campaign encouraging people to visit doctors for exams to detect thyroid

In another cancer awareness effort, Representative Debbie Wasserman Schultz, a Florida Democrat, has more than 350 House co-sponsors for her bill to promote the early detection of breast cancer in young women, teaching them about screening methods like self-exams and genetic testing.

Meanwhile, the foundation of the American Urological Association has a prostate cancer awareness campaign starring Hall of Fame football players. "Get screened," Len Dawson, a former Kansas City Chiefs quarterback, says in a public service television spot. "Don't let prostate cancer take you out of the game."

Nearly every body part susceptible to cancer now has an advocacy group, politician or athlete with a public awareness campaign to promote routine screening tests - even though it is well established that many of these exams offer little benefit for the general public.

An upshot of the decades-long war on cancer is the popular belief that healthy people should regularly examine their bodies or undergo screening because early detection saves lives. But in fact, except for a few types of cancer, routine screeninghas not been proven to reduce the death toll from cancer for people without specific symptoms or risk factors - like a breast lump or a family history of cancer - and could even lead to harm, many experts on health say.

That is why the continued rollout of screening campaigns, and even the introduction of a Congressional bill, worries some health experts. And these experts say such efforts add to the large number of expensive and unnecessary treatments each year that help drive up the nation's health care bill. Rather than heed mass-market calls for screening, these experts urge people without symptoms or special risks to talk to their own doctors about what cancer tests, if any, might be appropriate for them.

Blanket screenings do come with medical risks. A recent European study on prostate cancer screening indicated that saving one man's life from the disease would require screening about 1,400 men. But among those 1,400, 48 others would undergo treatments like surgery or radiation procedures that would not improve their health because the cancer was not life-threatening to begin with or because it was too far along. And those treatments could lead to complications including impotence, urinary incontinence and bowel problems.

Then there is the economic cost. There are no credible estimates for the amount that routine cancer screening contributes to the approximately $700 billion spent each year in this country on unneeded medical treatment of all types. But health policy experts say such screenings and the cascade of follow-up tests and treatments do play a role.

For example, Americans spend an estimated $4 billion annually on mammograms, according to Dr. David H. Newman, author of the book "Hippocrates' Shadow: Secrets from the House of Medicine." Some of those tests cause false alarms that lead to unnecessary follow-up surgery on normal breasts, at a cost of $14 billion to $70 billion over a decade, according to Dr. Newman, the director of clinical research in the department of emergency medicine at St. Luke's Roosevelt Hospital Center in Manhattan.

Check Your Neck?

Cancer awareness campaigns can be a disservice to the public by making people overestimate their risk of dying from cancer, according to Dr. Steven Woloshin, a researcher at the Dartmouth Institute for Health Policy and Clinical Practice. Thyroid cancer, for example, is a rare disease that kills an estimated 1,600 Americans a year. But the campaign called "Check Your Neck" makes it seem as if everyone should worry about the disease, Dr. Woloshin said.

"Confidence kills. Thyroid cancer doesn't care how healthy you are," reads the text of one ad that has appeared in national magazines like People. The ads promote a quick physical exam, called palpation, in which doctors feel for unusual lumps in the thyroid, a small gland in the front of the neck. "Ask your doctor to check your neck. It could save your life."

The campaign is part of an effort by the Light of Life Foundation, an advocacy group for thyroid cancer patients founded by Joan Shey, who was told she had the disease in 1995.

A Manhattan advertising agency designed the ads as a pro bono project after one of its own employees was found to have the disease. Bernie Hogya, one of the creators behind the "Got Milk" ads, created the cancer awareness campaign. Full-page ads valued at $800,000 have run free in national magazines like Sports Illustrated.

Ms. Shey said the campaign was intended to save lives through the early detection of cancer.

Dr. R. Michael Tuttle, an endocrinologist at Memorial Sloan Kettering Cancer Center in Manhattan who is on the foundation's board, said he hoped the campaign would remind busy family care doctors and gynecologists to check routinely for the disease. The campaign could also prompt people with symptoms like nodules or swollen lymph nodes in their necks to see their doctors, Dr. Tuttle said.

But there is no evidence that routine neck exams reduce the risk of dying from thyroid cancer, said Dr. Barnett S. Kramer, the associate director for disease prevention at the National Institutes of Health, which has a cancer Web site describing the potential benefits and risks of many cancer screening tests. Most thyroid cancers are so slow-growing and curable that early detection would not improve their prognosis, he said, while a rarer form of thyroid cancer is so aggressive that a surge in screening would be unlikely to have an impact on the death rate.

But routine screening, he said, does have the potential to do harm because neck exams can find tumors that would not otherwise have required treatment, potentially setting off a cascade of unnecessary events like ultrasounds, needle biopsies in the neck, operations to remove the thyroid and complications like damage to the vocal cords. Meanwhile, Dr. Kramer said, the exams can miss some life-threatening cancers that are not detectable by touch.

The "Check Your Neck" campaign is one of many that prompt Dr. Kramer to compare mass cancer screening to a lottery. "In exchange for those few who win the lottery," he said, "there are many, many others who have to pay the price in human costs."


Source: New York Times
Link: http://www.nytimes.com/2009/07/17/health/...


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Last Updated on Saturday, 18 July 2009 21:44