According to a commentary published online Nov. 21 in the Journal of the National Cancer Institute, since the first guidelines on mammography screening were developed by the National Cancer Institute more than three decades ago, guidelines developed by advocacy and professional groups have focused on which individuals should be screened, rather than clearly defining the risks and benefits of screening.
The commentary written by Michael Edward Stefanek, P.h.D., the associate vice president of collaborative research in the office of the vice president at Indiana University, also explains that instead of ongoing discussions regarding who should be screened, excessive time has been spent debating guidelines. Stefanek advocates educating individuals about the possible harms and benefits of screening.
Controversy was sparked after the U.S. Preventative Task Force (USPTS) recommended against routine mammography screening for women aged between 40 to 49 years, and after more investigations of screening, especially after a study in Norway found a small and statistically insignificant reduction in breast cancer mortality in the group that was screened, after comparing cancer screening mortality in women who were screen and unscreened.
According to Stefanek, “similar ambiguity” exists for prostate cancer screening, he highlights that the results from the two largest and high quality investigations were conflicting, with the recent recommendation against PSA testing in healthy men issued by the USPTS.
The National Lung Cancer Screening Trial reported there was a relative decrease in lung cancer deaths of 20% among patients who underwent CT scans in comparison to individuals who received X-rays, although most of the positive results were false positives. Due to this situation, Stefanek concludes that regardless of all the examinations to date, we are on unsteady ground when we try to decide which patients should or shouldn’t undergo screening.
Stefanek raises the question of what the public has been taught regarding cancer screening, as the majority of the public invariably appear to believe that screening is nearly always a good idea and detecting cancer early is vital to saving lives. According to Stefanek, if debates about guidelines continue the public may continue to hold a biased view of screening. In addition, novel technologies, even with the potential for fighting cancer, will probably result in false negatives and positives, over and under treatment, and result in important patient harms.
Stefanek states that we have failed to truly educate the public regarding cancer screening, and that the strategy to screening needs to be changed. Stefanek writes that it is important to engage patients in decision making, tracking the number of individuals provided with information related to the benefits and harms of screening rather than only patients who are screening, as well as bringing together advocacy and scientific organizations with primary care provider organizations in this attempt to inform about the costs and benefits is needed.
Stefanek explains:
“If we agree on the premise that individuals are supposed to be informed before making medical decisions, including decisions about cancer screening, then the time and talent of such groups could be much better spent educating the public on the harms and benefits of cancer screening. Screening can be very beneficial (or not), and screening messages should reflect the complexity of this decision.”
Written by Grace Rattue