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Some Cancer Screening Tests More Reliable Than Others

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May 23, 2000 (New Orleans) -- As more and more screening tests are developed for cancer, people must work together with their doctors to determine which of them work and whether they want to be screened, advises an expert on cancer prevention.

"Consumers need to realize that nothing is all good or all bad, and that there may be negative aspects, as well as positive benefits, to cancer screening," Barnett Kramer, MD, tells WebMD. "Questions people need to ask themselves include what they will do if a test is abnormal, and if they will proceed to biopsy. Other questions include whether they will be treated, and if they know the consequences of treatment. If all of the answers to these other questions indicate that a person doesn't want to undergo biopsy or treatment, then there is probably no benefit from screening." Kramer, who is a deputy director with the National Cancer Institute, discussed cancer screening at a meeting of more than 22,000 cancer physicians.

Kramer emphasizes that education is critical to evaluating whether to undergo a particular screening test, as is a frank discussion with one's doctor. "Physicians should welcome the participation of an informed patient in decision making," he says.

The place of some screening tests in identifying cancers early when they can be more easily treated is well-known, according to Kramer. These tests include Pap smears for cervical cancer, fecal occult blood screening, or testing for blood in the stool, for colon cancer, and mammography for breast cancer in women over the age of 50. Other tests, such as mammography for women younger than age 50, sigmoidoscopy, a flexible tube that is inserted into the rectum, for colon cancer detection, and a spiral CAT scan, which is better than an X-ray, for detecting lung cancer, are not so well established. He says, "These are examples where it is necessary for physician and patient to work together to decide whether to undergo screening."

Kramer also emphasizes the role of medical research in determining which cancer screening tests work, and encourages people to participate in these studies. He says certain types of studies are the quickest and most convincing way to determine whether screening tests work.

Two types of screening tests Kramer is not currently recommending include lung cancer screening and genetic screening. "We have no information on the positive impact of these tests, nor do we know what happens when someone is identified as being at risk of a genetic disease. Until we have more information on this, widespread screening is not advisable."

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