The Risks of Cancer Screening
With More Cancer Screening and Earlier Testing, Overtreatment on the Rise
The Downside of Cancer Treatment
No question: Cancer treatment saves many lives. But it's serious, often involving surgery, toxic drugs, and/or radiation. Treatment can scar and damage bodies, increase the risk of other cancers, and reduce the quality and length of a person's life.
It's worth it if it saves your life. But what if it doesn't? Many people have to accept the risks of routine cancer screening in order for one person to benefit. And when a cancer is found, treatment is no walk in the park.
"We do major surgery. We give radiation, a known carcinogen. We give chemotherapy, also a known carcinogen," Kramer says. "It is difficult to make a healthy person better than they are, and that is the very high bar screening tests must clear."
Yet most doctors would agree that it would be wrong not to treat people with early cancers, says Stefan Gluck, MD, an oncologist at the University of Miami Sylvester Comprehensive Cancer Center.
"With any cancer, even the smallest one can be very aggressive," Gluck says. "I do not believe it is wrong to find cancer early and get rid of it."
Living With Uncertainty: The Limits of Science
Short of a cure, perhaps the greatest unmet need in cancer research is to find tests that tell us which tumors need to be treated.
"What we need to do as scientists is to find better tests. Tests that are more specific, cheaper, not expensive, and five to 15 years later show we are detecting more cancers and less people are dying," Gluck says. "But if the tests detect the same number of cancers and same numbers of people are dying, a test is not effective."
Nearly all patients treated for screening-detected cancers believe their treatment cured their cancer and saved their lives. But many if not most of them never needed to be cured at all. They were overdiagnosed and overtreated.
"Unfortunately right now we are left with diagnosing a large number of people without precise enough knowledge to spare those who don't need to be treated," Kramer says. "And because cancer is such a fearsome disease, we often feel that patients can't tolerate going untreated."