Why I'm saying no to a smear test
independent.co.uk
independent.co.uk
For example, most men who get prostate cancer die of something else first. The treatment often destroys quality of life, so is worse than the disease.
Also, you can't compare women's diseases to male diseases. Women have all kinds of body changes that men don't experience.
And doctors generally don't signup for heroic measures after retirement. They know when your time is up, prolonging life in an ICU is not living.
You're not going to live forever.
While that is true, it is also true that men who get prostate cancer die several years earlier than men who don't get prostate cancer, and treatment do increase life expectancy significant.
Two clear truths, but the implications are not as clear. A common theory is that the combination of older age and cancer results in a much lower margin for error, turning non-deadly "something else" into deadly "something else".
It becomes a question of definition if "something else" should be seen as independent of the cancer or not.
https://www.harding-center.mpg.de/en/fact-boxes/early-detect...
One of the reasons cancer screening is pushed so hard is because people use the wrong metrics. People look at 5 year survival rates, or cancer detection rates, to judge success.
Imagine 1000 men with aggressive prostate cancer who don't have screening. After 5 years about 440 of those men will die. That's a survival rate of 44%.
Now imagine those exact same men but pooled with 2000 men who do not have prostate cancer (because this is what screening does). After 5 years those men will still be dead. But the survival rate is now 81%.
This is the bias caused by over-diagnosis.
That seems like a pretty decent way to judge success.
https://gupea.ub.gu.se/handle/2077/57825 page 92: Our data confirm that an organized screening programme reduces mortality by ~30%, a level that is similar to evidence from the ERSPC and the PLCO trial (showing a 25–32% lower risk) (175).
biopsies can cause a stable tumor to metastasize [0]. Sometimes medical screenings are useful, but when you’re looking for problems and don’t actually have symptoms, practitioners have an incentive to find something to treat you for. Ideally you’ll be fired as a patient, but I’ve heard of doctors who do procedures and operate every time they can possibly justify it (“he owes money to everyone.”)
Imagine two groups of 1000 men over the age of 50. One group has prostate screening every year. The other group doesn't.
According to you the group that has screening will have better lives, because we'll be detecting cancer earlier and preventing death.
That isn't what happens.
In the group that doesn't have screening we see 7 men die from prostate cancer, and we see 210 men who die from any cause.
But in the group that does have screening we see exactly the same: 7 men die from prostate cancer, and 210 men die from any cause. But in this screening group we also see men having biopsies (160 men), and we see men having unnecessary surgery (which can lead to incontinence or impotence) (20 men).
The problem with screening is not that is misses things which are cancer. It's that it hits things which are not cancer but which look a bit like cancer.
https://www.harding-center.mpg.de/en/fact-boxes/early-detect...
What does the man who discovered PSA say about using it to screen populations?
"Testing should absolutely not be deployed to screen the entire population of men over the age of 50, the outcome pushed by those who stand to profit.
I never dreamed that my discovery four decades ago would lead to such a profit-driven public health disaster. The medical community must confront reality and stop the inappropriate use of P.S.A. screening. Doing so would save billions of dollars and rescue millions of men from unnecessary, debilitating treatments."
Any day I have a hospital appointment, it's usually at least a half day, or sometimes a whole day invested.
From initial research, to scheduling the appointment, to having to reshuffle other things in the calendar, to commuting there, to waiting in the waiting room, to having the test done, to going home, to waiting (anxiously) for results, to researching what the results mean, to getting the bill, to worrying about if insurance will find an excuse not to cover it, etc.
Overall, that's a lot of time and effort.
When someone can reduce this to a 5 minute test in a grocery store with no appointment, no paperwork, and a "we'll ring you afterwards only if something is up" policy, it will be a clear win
No screenings wins.