Hilda Bastian is cartoonist and writer at StatisticallyFunny blog
” … many people – including many doctors – just love gadgets and measuring things… … Actually, there’s too much monitoring in some health matters. Some monitoring could cause anxiety without benefit, or lead to actions that do more harm than good. “
Hilda Bastian is Editor etc at PubMed Health, blogger at Scientific American. Commenting on epidemiology with cartoons at Statistically funny.
The patient’s story began with a full-body CAT scan, a screening test used to detect tumors…
As a surgeon, I’m trained to crush cancer. For many years, every tumor I palpated and family I counseled drove me to hunt for cancer with vengeance, using every tool modern medicine has to offer. But recently, one patient reminded me that the quest to seek and destroy cancer can produce collateral damage.
” Margaret McCartney is diligent enough to dig deep into the evidence, brave enough to name names where necessary and lucid enough to capture a concept in a memorable sentence.
Welcome to the world of sexed-up medicine, where patients have been turned into customers, and clinics and waiting rooms are jammed with healthy people, lured in to have their blood pressure taken and cholesterol, smear test, bowel or breast screening done.
In the world of sexed-up medicine pharmaceutical companies gloss over research they don’t like and charities often use dubious science and dodgy PR to ‘raise awareness’ of their disease, leaving a legacy of misinformation in their wake. Our obsession with screening swallows up the time of NHS staff and the money of healthy people who pay thousands to private companies for tests they don’t need. Meanwhile, the truly sick are left to wrestle with disjointed services and confusing options.
Explaining the truth behind the screening statistics and investigating the evidence behind the hype, Margaret McCartney, an award-winning writer and doctor, argues that this patient paradox – too much testing of well people and not enough care for the sick – worsens health inequalities and drains professionalism, harming both those who need treatment and those who don’t. “
Almost every time someone wants to proclaim the US to be the “best in the world” in health care, they point to survival rates. The metric people should be using is mortality rates…
Survival rates refer to the percent of people who live a certain amount of time after they’ve been diagnosed with a disease. But there are real problems in using survival rates to compare the quality of care across systems.
Le cancer fait l’objet de toutes les attentions, notamment en matière de dépistage. Au risque parfois d’entraîner des traitements excessifs altérant souvent de manière irréversible la qualité de vie…
” Pendant des décennies, il a été affirmé péremptoirement et sans preuve scientifique que plus le diagnostic d’un “cancer” était précoce plus on avait de chances d’en guérir. Cet argument était peut être vrai dans les années 60 lorsque le traitement se résumait à la chirurgie et qu’on ne guérissait guère plus de 30% de malades mais il ne l’est pas aujourd’hui. Le dépistage organisé a transformé des monceaux de gens normaux, chez lesquels on a trouvé quelques cellules malignes, en cancéreux. Ils ont subi examens complémentaires, opérations et traitements médicaux (chimiothérapie) et/ou radiothérapie et ont été ensuite déclarés “guéris”ep. Cela a permis de faire croire à une épidémie galopante du cancer et en même temps aux progrès rapides de la médecine puisque le taux de guérison des cancers augmentait également très vite (on guérit facilement les cancers qui n’évoluent pas) . Beau doublé ! “
Nicole Delépine est responsable de l’unité d’oncologie pédiatrique de l’hôpital universitaire Raymond Poincaré à Garches. Fille de l’un des fondateurs de la Sécurité Sociale et thérapeute engagée, elle a récemment publié La face cachée des médicaments et Le cancer, un fléau qui rapporte.
Mammography associated to breast cancer over-diagnosis with no significant reduction in mortality
“… in technically advanced countries, our results support the views of some commentators that the rationale for screening by mammography should be urgently reassessed by policy makers …”
Objective To compare breast cancer incidence and mortality up to 25 years in women aged 40-59 who did or did not undergo mammography screening.
Design Follow-up of randomised screening trial by centre coordinators, the study’s central office, and linkage to cancer registries and vital statistics databases.
Setting 15 screening centres in six Canadian provinces,1980-85 (Nova Scotia, Quebec, Ontario, Manitoba, Alberta, and British Columbia).
Participants 89 835 women, aged 40-59, randomly assigned to mammography (five annual mammography screens) or control (no mammography).
Interventions Women aged 40-49 in the mammography arm and all women aged 50-59 in both arms received annual physical breast examinations. Women aged 40-49 in the control arm received a single examination followed by usual care in the community.
Main outcome measure Deaths from breast cancer.
Results During the five year screening period, 666 invasive breast cancers were diagnosed in the mammography arm (n=44 925 participants) and 524 in the controls (n=44 910), and of these, 180 women in the mammography arm and 171 women in the control arm died of breast cancer during the 25 year follow-up period. The overall hazard ratio for death from breast cancer diagnosed during the screening period associated with mammography was 1.05 (95% confidence interval 0.85 to 1.30). The findings for women aged 40-49 and 50-59 were almost identical. During the entire study period, 3250 women in the mammography arm and 3133 in the control arm had a diagnosis of breast cancer, and 500 and 505, respectively, died of breast cancer. Thus the cumulative mortality from breast cancer was similar between women in the mammography arm and in the control arm (hazard ratio 0.99, 95% confidence interval 0.88 to 1.12). After 15 years of follow-up a residual excess of 106 cancers was observed in the mammography arm, attributable to over-diagnosis.
Annual mammography in women aged 40-59 does not reduce mortality from breast cancer beyond that of physical examination or usual care when adjuvant therapy for breast cancer is freely available. Overall, 22% (106/484) of screen detected invasive breast cancers were over-diagnosed, representing one over-diagnosed breast cancer for every 424 women who received mammography screening in the trial.
” You’re feeling fine when you go for your annual physical. But your mammogram looks a little funny, or your PSA test is a little high, or you get a CT lung scan and a nodule shows up. You get a biopsy, and the doctor delivers the bad news: You have cancer. Because you don’t want to die, you agree to be sliced up and irradiated.
Then, fortunately, you’re pronounced a -cancer survivor-.
You’re glad they caught it early.
But maybe you went through all that pain for nothing. “…