Wednesday, November 20, 2019

Do you really need cancer screenings at the doctor?

Below are the results of my research.  I am not a medical professional and make no claims to be.  Here are the recommended cancer screenings for women:
  • Breast Cancer Screening - annually for women 40-55, every two years for women over 55 [1]
  • Cervical Cancer Screening - every three years for women in their 20s, every five years for women 30-65 years of age, at their discretion for women over 65 years of age [1]
If someone is at risk for cancer, then I certainly think they should get screened.  However, for those not at risk, I do not see the reason for screenings.  Just as a non-smoker would not get a cancer screening for lung cancer, I ask myself why those not at risk for other cancers are being encouraged to get screened.  Why undergo a painful screening that could do immense harm in the event of a false positive?  False positives are when the doctors think you have cancer when you really don't.  This leads to biopsies, surgeries, body parts being removed, and a lot more poking-and-prodding that can have permanent consequences.

Breast Cancer False Positives
"The more mammograms a woman has, the more likely it is she will have a false positive result that requires follow-up tests. The chance of having a false positive result after 1 mammogram ranges from 7%-12%, depending on your age (younger women are more likely to have a false positive results). After 10 yearly mammograms, the chance of having a false positive is about 50%-60%.  The chance of a false positive result is higher among younger women and women with dense breasts. (Most women younger than 50 have dense breasts, so there's overlap among these groups."

Cervical Cancer False Positives
"We need to remember that informed consent is a legal and ethical requirement for all cancer screening, some women will choose not to have pap tests and mammograms. So often women are ordered, pressured and even coerced into testing with no real information on the actual benefits and risks with screening.  I’ve watched other countries and believe the Finns and Dutch are the ones to watch when it comes to cervical screening, they’ve followed the evidence and put women first, all women, the small number who might benefit from cervical screening and the vast majority who can never benefit but can be harmed by false positives, excess biopsies, and over-treatment."[3]

Breast Cancer Risk Factors
"All women are at risk for breast cancer. Increased risk factors include a family history of cancer, atypical hyperplasia, delaying pregnancy until after age 30, no children or no breast-feeding, early menstruation (before age 12) late menopause (after age 55), current use (in the last 10 years) of oral contraceptives, more than 4 years of hormone replacement use, postmenopausal obesity, alcohol consumption, exposure to second-hand cigarette smoke, low physical activity and exposure to radiation." [4]

Cervical Cancer Risk Factors
"Human papillomavirus (HPV) is found in about 99% of cervical cancers....HPV is estimated to be the most common sexually transmitted infection in the United States."[5]
While rare, those not at risk for sexually transmitted disease could still get cervical cancer - "When a nun has symptoms suggestive of cervical cancer, that diagnosis should be considered as seriously as for any other woman. Irregular vaginal bleeding, inter-menstrual bleeding or recurrent vaginal discharge, should lead to a full pelvic examination under anesthesia."  [6]

Money, Power, and Greed
"The United States performs screening, particularly for cancer, more commonly than other advanced countries. We spend tens of billions annually on cancer screening, including $8 billion for breast cancer, over $6 billion for cervical cancer, and $3 billion for prostate cancer.  Why do we encourage large numbers of healthy people to undergo testing that may reveal some future problem, without informing them of the efficacy of these tests and their possible harms, while insisting that people who actually need medical intervention give informed consent? The reasons are more political than scientific. Patient-advocacy groups attract donations, gain prestige, and accumulate power by pushing screening for particular diseases. Physician-specialty groups promote screening in their areas of expertise. Most important, politicians of both parties garner support by funding screening programs for important constituent groups. Yet the effectiveness of screening is overrated: many screening programs mislead the public, waste scarce medical resources, and harm the people they are supposed to help." [7]

References
1.  "American Cancer Society Guidelines for the Early Detection of Cancer."  American Cancer Society, 30 May 2018.
2.  "Accuracy of Mammograms." The Susan G Komen Breast Cancer Foundation, 26 Jun 2019.
3.  "There's a better way to screen for cervical cancer." Healthy Debate Opinions, 13 Apr 2016.
4.  "Facts and Info."  Breast Cancer Research and Assistance Fund, 1 Jan 2015.
5.  "Cervical Cancer Overview." National Cervical Cancer Coalition, 1 Jan 2019.
6.  "Nuns, virgins, and spinsters. Rioni-Stern and cervical cancer revisited."  Gynecological Oncology, 23 Sep 2011.
7.  "Stop Overscrening for Cancer."  City Journal, 4 Apr 2016.

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