To Screen Or Not To Screen, Is That Really the Question?
There is a lot of confusion in the minds of many people about whether they should be screened for cancers such as breast (if they're a women in their 40's) or prostate (if they're a guy in a regular risk group). The confusion is the result of the public debate between scientists and public health officials about large screeening programs using mamograms for breast cancer and the PSA (Prostate Specific Antigen) blood test for prostate cancer. You can't dispute the scientists facts. For example, a large Norwegian study of 40,000 women pegged the rate of overdiagnosis of invasive breast cancer at 15 - 25%. That means that as many as one in four women in the group that was being followed who were told that they had invasive breast cancer could have been treated unnecessarily with chemotherapy, radiotherapy and surgery for a disease that might not have killed them. We similarly know that approximately one in seven Canadian men will be diagnosed with prostate cancer but that only one in 28 will die from it. But for every case of overdiagnosis we know of specific examples where early screening was life saving and as guys we are worred when we see guys like Frank Zappa and Jack Layton die in the prime of their lives from a cancer that can be screened for. So what are we to take away from these confusing facts?
First and foremost, screening works and is important. However, what applies to large populations may not apply to you and this is where your doc comes in to the picture. Given your specific family history and background, you and your doc need to discuss what screening is best for your particular case and what to do with the results when they come back. It may be very reasonable for you to have a mamogram even though you're in your 40's and you are willing to go through a biopsy and perhaps the anxiety of waiting for confirmation of what comes back.
The key here is not to throw the proverbial baby out with the bathwater and to remember that the more we learn, the more we realize that medicine has to be individualized and that what applies to millions might not apply to a single patient you're seeing in your office. That's where some of the art of medicine comes in to play.