(Ed. Note: Regular readers know this medical blogger, Dr. Robert Centor, a medical professor in Alabama. DB is short for Dr. Bob. DB writes short and insightful posts on important matters, while stipulating his views are his own and not those of his employer. We have taken the liberty of using his entire post, knowing most readers will not likely click to a medical professor’s site…or at least, they won’t until they get to know him better.)

What are patients to think about the American Cancer Society’s apparent shift in a long-held position about breast and prostate screening?

Reading the news, the debates can be, at the least, bewildering to the public and alarming to people who have higher than normal risks for these diseases.

Sit right down here with the good doctor and he will make this clear for you.

You will feel better, not worse, after reading it no matter what your risk factors are.

DB’s Medical Rants

“Bravo to the American Cancer Society! (Disclosure – my daughter worked there for several years)

“In Shift, Cancer Society Has Concerns on Screenings

“It is quietly working on a message, to put on its Web site early next year, to emphasize that screening for breast and prostate cancer and certain other cancers can come with a real risk of overtreating many small cancers while missing cancers that are deadly.

“We don’t want people to panic,” said Dr. Otis Brawley, chief medical officer of the cancer society. “But I’m admitting that American medicine has overpromised when it comes to screening. The advantages to screening have been exaggerated.”

“This piece in the NY Times is thoughtful and balanced. Whenever we discuss diagnostic testing, we must understand both the benefits and the risks. The American Cancer Society has stepped up to the plate and recognized that we need to understand both benefits and risks.

“Yesterday I gave a talk on guidelines, which I will give again tomorrow. In that talk I make a major point in emphasizing competing guidelines. We have had competing guidelines concerning cancer screening. The American Cancer Society is showing leadership and courage in this new direction. (Emphasis added)

“If breast and prostate cancer screening really fulfilled their promise, the researchers note, cancers that once were found late, when they were often incurable, would now be found early, when they could be cured. A large increase in early cancers would be balanced by a commensurate decline in late-stage cancers. That is what happened with screening for colon and cervical cancers. But not with breast and prostate cancer.

“Still, the researchers and others say, they do not think all screening will — or should — go away. Instead, they say that when people make a decision about being screened, they should understand what is known about the risks and benefits. (Emphasis added)

“This discussion is healthy for physicians. It should remind us all that medical decision making is rarely black and white. Politicians would like to simplify the complexity of improving medical care. Insurance companies (including Medicine) want to make rules about testing and treatment. Lawyers want excuses to sue physicians about missing diagnoses. (Emphasis added)

“We must always balance errors of omission and errors of commission. This article should inform those who think medicine is really easy.” (Emphasis added)

Source: DB Medical Rants, October 21, 2009