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Cancers: To Screen; Perchance to Treat? — 3 Comments

  1. Dr. Welch also covers this in his excellent book, Should I Be Tested For Cancer? In it, he elaborates on the concept of “pseudodisease” – early stage abnormalities that may or may not progress to actual disease.

    You’re correct in observing that fear is the prime mover in our health scare system. In my book, I cite an example of women with early stage ductal carcinoma in situ (DCIS) that may or may not be actual cancer. In the study cited, these women chose the most aggressive treatment possible – double mastectomy – to prevent progression of their DCIS to breast cancer at a rate even more aggressive than their surgeons.

    This doesn’t bode well for more patient engagement in their medical decision-making if it’s to be driven by unrealistic fear instead of rational balancing of risks and benefits.

    We somehow have to get patients to focus on the risks of their treatments as much as on the risks of their disease. This is especially true for the toxic treatments employed in cancer care. As you point out, the true risks with many cancers today is often far less of a threat than they imagine.

    This will be easier said than done, I fear. This post is a good start, however. Congratulations on a job well done.

  2. John,
    Thx for your insights. I totally agree.

    A friend and colleague of mine, now unfortunately deceased, Rob Buckman, was a noted oncologist, writer of many books and a Monty Python-ese communicator of cancer research. More that once I saw him do an exercise with an audience where he painted a picture of someone getting chest pains while shovelling snow. Doc says very TINY heart attack, 90% chance no issues whatsoever will ever happen again, and asks are you mildly, moderately or very concerned. Vast majority of audience puts up hands in “mildly” concerned.

    The he fictionalizes a cancer of the heart – same scenario exactly – 90% chance that absolutely zero issues just leave it alone. Ask audience if now mildly, moderately or very concerned.

    I’m sure you guessed what the answer is – most are now VERY concerned.

    I saw him do this at least 2x to very different audiences – worked the same each time. Just a huge unreasonable fear of cancer….Even though everyone in the room could see where he was going, they were helpless to say they were only mildly concerned in the second scenario…

  3. Can non-small cell lung cancer be found early?Usually symoptms of lung cancer do not appear until the disease is already in an advanced, non-curable stage. Even when symoptms of lung cancer do appear, many people may mistake them for other problems, such as an infection or long-term effects from smoking. This may delay the diagnosis.Some lung cancers are diagnosed early because they are found as a result of tests for other medical conditions. For example, lung cancer may be found by imaging tests (such as a chest x-ray or chest CT scan), bronchoscopy (viewing the inside of lung airways through a flexible lighted tube), or sputum cytology (microscopic examination of cells in coughed up phlegm) done for other reasons in patients with heart disease, pneumonia, or other lung conditions. A small portion of these patients do very well and may be cured of lung cancer.

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