To screen or not to screen, that is the question.
Whether ’tis nobler in the mind to [refuse to] suffer The slings and arrows of outrageous over-testing,
Or to [sensibly] take arms against a sea of [diagnosed] troubles, And by opposing [hope to] end them?
With apologies to Shakespeare, his words rather lend themselves to opposite ends of an argument gathering momentum among the medical fraternity.
Is screening for early identification of the symptoms of “the Big C” vital for your health? Or is it a slippery slope to potentially damaging and invasive treatments for something that might never develop?
There’s a rapidly growing chorus of voices deeply concerned about over-testing and over-treatment. This includes Reuters health editor Ivan Oransky and, physician-author and Dartmouth Professor of Medicine, Dr H. Gilbert Welch – author of Overdiagnosed: Making People Sick in the Pursuit of Health. Research co-led by Professor Welch, just published in the New England Journal of Medicine, is “the most detailed look yet at overtreatment of breast cancer”.
Their message is clear: over diagnosis is a medical misstep that can tragically do more harm than good.
The press often carries contradictory stories about preventative action. For example, an interview with Sharon Osbourne – confiding to a national daily about her “precautionary” double mastectomy – followed close on the heels of a first-person account of a routine test leading to a similar, but now deeply regretted, operation.
Schoolteacher Miriam Pryke, who regrets following medical advice, said she had since researched treatments and statistics and realised “screening finds many cancers that are not progressive and aren’t life-threatening, even if they are classed as ‘invasive’”.
She added: “I felt as if I had effectively been railroaded into a brutal treatment which may well have been unnecessary.”
Research, recently published by The Lancet,points to the nature of the dilemma:
“…screening prevents about 1,300 deaths per year in Britain but can also lead to about 4,000 women having treatment for a condition that would never have troubled them. This means that for every death that is prevented, three women are over-diagnosed.”
As The Lancet concludes, “information should be made available in a transparent and objective way to women invited to screening so that they can make informed decisions.”
Often missed in the “routine testing” culture is the important consideration of how different mental states might exacerbate disease. Such an impact on cancer cases was highlighted in a recent “What is Psychology?” article recounting three exceptional examples that “illustrate the critical role of psychological factors in physiological health.” Patients, who believed the treatment they were receiving would produce positive effects, actually experienced real health benefits, even though “the ‘treatment’ they received was nothing more than a medical sham”. Patients “who had little faith in the treatment and who felt their situation was hopeless, experienced rapid deterioration of health, even in the absence of any obvious medical cause”.
A more recent case also demonstrates the power that thoughts can have on health. But this time the patient, who had been solemnly informed by her oncologist “it was time to get her affairs in order”, experienced a full recovery from a Stage 4 cancer after deciding to forgo further treatment.
Reflecting on that decision, after 13 years of defining herself by her disease, Karen Dennis said: “I didn’t see the point in all these scans and diagnostic work when there’s no remedy. There’s anxiety that accompanies all this testing – not only for me, but for my family and friends. I told [my family doctor], I’m feeling pretty good right now and I just want to be that way for as long as I can.”
Two years later, however, another scan found no trace of the cancer on her. Sharing what she learnt, Dennis spoke of “transcending fear”, adding she had simply resolved to “have a lot of fun and do all the things that make my heart sing…
“I never dreamed it would have any impact on my outcome, but it did.”
Following her recovery, she was convinced healing comes “from within” whether “influenced by me”, down to “luck” or a result of “divine intervention”.
Still other cancer survivors unreservedly attribute their recovery to the divine as a source of spiritual strength by which they could overcome their fear. One of the more common phrases in the Bible is “fear not”, usually associated with divine Love’s reassurance to those seeking comfort or healing in prayer.
This was certainly a message Anne Morin wanted to hear when, living under the shadows of a family history of breast cancer, she found a painful lump. For two years she prayed daily and gained spiritual insights from sacred texts, which helped her calm her fear before sleeping each night. Then there finally came a time when she found herself completely unafraid. Coincidentally, the recurring pains disappeared from then on and have not returned.
Karen and Anne present two examples among many which prompt questions about the part each of us can play in addressing disturbing diagnoses – not by rose-tinted thinking, blind faith or misplaced optimism but through identifying whatever helps us to lessen our fears.
So, back to the original question: “To screen or not to screen?”
Health professionals on both sides of the argument agree screening can spot early symptoms of a potential cancer. But if the same symptoms appear in many who will never develop the disease it makes sense to ask if it’s wise to subject so many people to invasive treatment that can be deeply distressing, both physically and emotionally.
What should also be considered is whether the process itself might be fanning the flames of fear, actually hastening the very outcome the action is intended to forestall.
While scientists diligently research such concerns, perhaps each of us can ponder another Shakespearean paraphrase: “To fear or not to fear, that is the question”.
As his great rival Milto might have written: “He who reigns within himself and rules [his] fears is more [healthy] than a king.”
This was originally posted by The Independent with the same title: Cancer testing – yes or no? Either way, let’s screen out the fear.