Dreading the colonoscopy

For most people, having a colonoscopy holds only slightly more appeal than, say, having their teeth gouged out one at a time with a rusty chisel.

So I was rather bemused when AmSurg, a for-profit ambulatory surgery company, emailed me a link last week to a new YouTube video, praising the colonoscopy experience as “not that bad.”

Cheesy soul singer and a trio of women in silver miniskirts – what’s not to like? Oh, wait. Colonoscopy.

Few people would argue that the colonoscopy isn’t a valuable screening and diagnostic tool. Indeed, a brand-new study published a couple of weeks ago in the New England Journal of Medicine confirmed this: It concluded that when colonoscopies are performed and precancerous polyps in the colon are detected and removed, the death rate from colorectal cancer is reduced significantly.

In view of this compelling evidence, it’s unfortunate that colonoscopy is lumbered with so much negative baggage.

Many of the people who posted at Medicine.net about their colonoscopy were ambivalent or found the experience downright miserable. “The most painful experience I have ever had and would not go back,” wrote one person. “Painful” and “degrading” was someone else’s assessment. Another commenter found it assaultive and reported waking up from the anesthesia several times during the procedure. “I hate that I will have to get this again eventually, and I will only consent because I want to keep myself as healthy as possible to be around for my kids, but I dread it and wish I didn’t have to,” she concluded.

The medical community acknowledges there are plenty of barriers to discourage people from undergoing a colonoscopy, especially routine screening colonoscopies in those who are otherwise healthy. When a group of Australian researchers reviewed a collection of more than 50 previous studies on patient attitudes toward colonoscopy, they found the laxative bowel preparation was “the most burdensome part” for most people. Anxiety, embarrassment, worries about pain, and fear of finding cancer also were reported as significant issues. The findings were published last month in the Patient Education and Counseling Journal.

Other studies have noted practical concerns as well. One of them is lack of health insurance. Scheduling and logistics also can be a problem; the anesthesia requires not only taking a day off work for the working-age population but also someone to accompany them and drive them home after the procedure.

Add it all up and it’s not particularly surprising that adherence to colonoscopy screening guidelines in the U.S. – recommended for adults between the ages of 50 and 75 – is less than ideal. According to recent figures from the Minnesota division of the American Cancer Society, one in three Minnesotans who are 50 and older have never been screened. Nationally, about four out of 10 adults aren’t up to date on the screening.

Is there a way to improve this? Maybe getting rid of some of the myths surrounding the procedure would help, suggest the folks at Providence Cancer Center of Oregon and Washington. The prep is short-lived, the procedure is done under anesthesia and most people only need to take a couple of days off work, they explain. Their advice: “Get over it, please – and get screened.”

It should be pointed out that colonoscopy does carry some risk of complications. Bleeding and perforation can occur, and some people may become ill from the prep. Serious complications don’t appear to be common, however; one study put the incidence at about 5 per 1,000 procedures.

For what it’s worth, many people who undergo the procedure discover it wasn’t as bad as they thought it would be. Still, it’s not hard to see why the colonoscopy is heartily disliked or why patients would balk at having one. There’s ongoing research on alternative, less invasive screening methods such as virtual colonoscopy, but to date none of them have been shown to be as reliable or effective as the standard colonoscopy. Until we can come up with something better, the dreaded colonoscopy is the best we have.

2009: The health year in review

If the annual top-10 lists are any indication, health care reform and the emergence of the H1N1 novel influenza virus were among the biggest health happenings this past year.

As everyone compiles their traditional year-end reviews of the 2009 milestones in health care, these two are among virtually all the picks, including the Harvard Health LetterUSA Today, and the Wall Street Journal.

WebMD offers both a list and a slideshow of its choices for the top 10 stories. For a worldwide perspective, the World Health Organization has put together a photo essay of the top stories about global health in 2009. And at Kaiser Health News, there’s an entertaining retrospective of political cartoons about health care reform.

It’s intriguing to see some of the other choices among the lists of the top 10. For instance, Doctors Without Borders singled out malnutrition and neglected diseases as among the top humanitarian crises of 2009. One of the picks of the Harvard Health Letter editors was research suggesting there’s a social dimension to weight gain and other health-related behaviors – in other words, "Do your friends make you fat?"

This being the end of a decade, lists of the top health/medical advances of the past 10 years are being compiled as well. At his blog, Dr. Aidan Charles has put together a slate of the top 10 and is asking readers to vote on the three most significant (polling closes on New Year’s Eve). His ballot includes battlefield medicine, the human genome project, the public health benefits of smoking bans, and the growth of online health information.

MedPage Today also is running a series, "The Changing Face of Medicine, 1984-2009," that takes a look at developments over the past 25 years in medicine. The first couple of installments, which include video and expert commentary, assess our progress in treating peptic ulcers and HIV/AIDS.

Physician/blogger Richard Fogoros proposes his own list: the 10 most overblown health stories of the past decade. Among his picks: mad cow disease, an "epidemic of epidemics," and the persistence of the belief that vaccines and autism are linked.

If a local list of the biggest health care stories of the year were compiled, it would surely include health care reform and H1N1, both of which hit close to home this past year. We saw local medical providers work overtime as they prepared for pandemic influenza, gave out vaccinations and fielded questions and concerns from a worried public. The health care reform debate also went local when Willmar hosted a standing-room-only town hall meeting in August.

Other stories I’d put on the list are the hiring of a new chief executive at Rice Memorial Hospital, the grand opening of a new addition at Meeker Memorial Hospital in Litchfield, the opening of the Willmar Center for Diagnostic Imaging, the opening of the newly integrated Willmar Cancer Center (watch for an open house in another month or so), the establishment and adoption of a new strategic plan that will shape Rice Hospital’s future direction in the next few years, and physician recruitment efforts that have been stepped up and have begun to pay off with some successes this past year.

Are there other local stories you’d add to the top 10? Which one would you select as the most important? Leave your feedback in the comment section below.

West Central Tribune photo by Rand Middleton

Curbing unnecessary testing

Dr. Lucy Hornstein, a family practice physician who blogs at Musings of a Dinosaur (and has recently published a book), made an intriguing suggestion this week: If a patient asks for a test the physician deems is medically unnecessary and the test results show nothing out of the ordinary, the patient should pay for it. But if there’s an abnormal result, insurance should pay.

There’s no denying that tests are contributing a significant chunk to the overall cost of medical care in the United States. Some of it, as Dr. Hornstein points out, is defensive medicine on the part of physicians. But there’s more to it than this, she writes:

At issue is what to do when patients request/demand inappropriate testing. This has been driven home to me at least three times just in the last week.

From patients with no family history of anything and perfectly normal blood tests (cholesterol panels, blood sugars) a year ago who “really want it done again” despite the USPSTF recommendation of 3-5 year intervals for these screenings, to women who demand annual paps “just to make sure everything’s OK in there,” I find myself struggling to explain the downside of unnecessary testing. “But the insurance will pay for it,” they respond. “What’s the harm?” Sometimes I do it; sometimes I stand my ground; but the encounters often leave me drained and upset. How much is my inability to explain these things adequately, and how much is it the deeply ingrained American idea of “more is better,” “better safe than sorry,” and so on? There seems to be no way to tell.

She reasons that if insurance companies only pay for medically unnecessary testing when the results are abnormal, “patients have a little more skin in the game by taking on the risk of having to pay for negative tests. As most of them claim to only want the testing for ‘peace of mind,’ it stands to reason that many of them would also be willing to pay.”

It’s true that health insurance tends to insulate most of us from the actual cost of health care. This is becoming less the case as more and more people switch to higher deductibles or health savings accounts, which has increased their out-of-pocket expenses. The idea is that when consumers have to pay for some of their care themselves, they’re more likely to think twice before seeking care that might be unnecessary.

I’m not sure if this same dynamic would play out for medically inappropriate screening, especially when the determination whether to cover it wouldn’t be made until after the fact. Nor is it clear how much money would actually be saved. Regardless of who pays the bill, there’s still a cost to the provider for staffing, supplies, use of equipment and so on. 

What’s unnecessary, of course, might be in the eye of the beholder. What price tag do you put on peace of mind? People don’t always go to the doctor because they want to know what’s wrong with them; oftentimes they go because they want reassurance that something isn’t wrong with them. And as we’ve seen in the case of the U.S. Preventive Services Task Force and its recent new recommendation on mammograms, it can be very hard to sell the public on the concept that testing isn’t always what it’s cracked up to be. 

In any case, Dr. Hornstein has made an interesting proposal, and I’m curious to know what readers think.

Update: When it comes to patient requests for additional testing, are doctors darned if they do and darned if they don’t? Here’s another look at this issue.

Taking care of the boomers

The baby boom generation is the largest age cohort in American history, but it seems they’re underrepresented in the doctor’s office when it comes to preventive services such as adult immunizations and screenings, a new report has found.

The study, part of a collaborative project by the American Medical Association, the American Association of Retired Persons and the U.S. Centers for Disease Control and Prevention, was released last month. It calls on the broader use of clinical preventive services among adults ages 50 to 64.

From the report:

By 2015, one of every five Americans will be between the ages of 50 and 64. As they enter this age group, 70 percent will already be diagnosed with at least one chronic condition and nearly half will have two or more. The resulting disease and disability may seriously compromise their ability to carry out the multiple roles they play at this point in their lives. National experts agree on a set of recommended clinical preventive services that can help detect many of these diseases, delay their onset, or identify them early in their most treatable stages. Despite the cost-effectiveness of many of these services, the percent of adults who are up to date on receiving them is low.

The sheer numbers of the baby-boom generation, defined as those born between 1946 and 1964, make it urgent to address their health needs sooner rather than later. In 2007, the report notes, there were nearly 55 million American adults between the ages of 50 and 64. By 2015, there will be nearly 63 million boomers in middle age, a time when chronic health issues have a way of sneaking up on us.

Health care spending among Americans in their middle years has been growing, according to a survey by the Medical Expenditure Panel of the U.S. Agency for Healthcare Research and Quality. The survey found that adults ages 45 to 64 incurred $370 billion in health care expenses in 2006 – $183 billion higher than in 1996. Average spending per individual also rose, because of both increasing use of services and the higher cost of health care services.

More widespread screening and preventive care could help catch many health issues sooner and lower some of the costs associated with illness and chronic disease, the joint AMA/AARP/CDC report says. The report proposes 14 key indicators on which providers should focus: screening for cholesterol, cervical cancer, breast cancer and colorectal cancer; monitoring the risk for obesity, smoking, high blood pressure, risky alcohol use and moderate depression; vaccinations for pneumonia and influenza; promotion of physical activity; and ensuring men and women ages 50 to 64 are up to date with specific screening and preventive care.

How do the boomers stack up on these measures? They fare pretty well on some of them. For instance, nearly 90 percent of people in the 50-to-64-year-old age group have had a cholesterol screening within the past five years, and 80 percent of women have had a mammogram within the past two years. Only about half, however, have been screened for colorectal cancer, 42 percent have had a flu shot within the past year, and 27 percent report no leisure-time activity within the past month.

It’s interesting to learn that boomers, who are often unfairly perceived as entitled and self-absorbed, aren’t always up to date when it comes to their health care. Then again, this generation has always been far more diverse than they’re given credit for. While some of them were grooving at Woodstock, others were in the jungles of Vietnam. Some lived the flashy young urban professional lifestyle in the 1980s while others held down jobs and raised families.

It’s possible that many middle-aged boomers aren’t aware of what screenings and preventive services they should be receiving. Or maybe they simply don’t see themselves as – perish the thought- getting older.

Reaching out to a population this vast and this diverse isn’t going to be easy, so the report recommends the development of collaborative strategies involving state and national public health practitioners, clinical service providers, policymakers and others to “make effective screening, counseling, vaccinations and other recommended services a routine part of prevention for the nation’s adults.”

There’s a fair amount of debate about the cost-vs.-benefit of screening and prevention among those who are younger and those who are elderly. The consensus seems more clear that among the middle-aged, the benefit generally outweighs the cost and that it’s not too late for this age group to start reaping some of those benefits.

Photo: Jimi Hendrix at the Woodstock Festival, 1969. Associated Press file photo.

The bell curve


In statistics there’s something known as the bell curve. Values that are distributed normally tend to cluster at the center, tapering away to outliers on either end. If you were to plot them on a graph, the curve assumes a bell shape – sometimes flat and sometimes steep, depending on what you’re measuring and the data you’re using.

Health care often relies on principles similar to the bell curve for making diagnoses, managing diseases and recommending screenings and vaccinations. A particular set of symptoms, for instance, will usually suggest one or more probabilities for what the diagnosis might be. Some diseases are more likely to be found among children; others, such as heart disease, tend to occur among adults.

Real life, of course, isn’t always this predictable. Common diseases sometimes present themselves in uncommon ways, or proceed down a path that isn’t typical. Not all patients can be treated the same. The challenge for the physician is to be aware of the outliers yet not lose sight of the most likely probabilities.

Figuring out this balance between what’s right for the group and what’s right for individuals has never been easy, a fact that has been hammered home the past couple of weeks in the wake of the U.S. Preventive Services Task Force’s controversial new recommendation to offer fewer mammograms, especially to women in their 40s. The task force’s epidemiology was sound; after all, breast cancer is statistically most common among women in the 50- to 70-year-old age group. But how should we account for women on either end of this particular bell curve – women older than 70 and women in their 40s and younger? Where do they fit into this picture?

I’m not sure this is a question that epidemiology is equipped to answer. The fact that younger women are not the majority when it comes to breast cancer doesn’t mean their needs can be brushed aside. Indeed, breast cancer often is more aggressive in this age group, something that isn’t always reflected when large amounts of data are compiled and analyzed. It’s one of the dangers of statistical analysis: The sheer numbers can obscure critical differences among subgroups and lead to conclusions that are overly broad.

Did the USPSTF fail to account for the bell curve? Plenty of critics think the task force totally missed the boat.

One of the accusations has been that the task force’s analysis was too limited. Its study focused primarily on women considered at average risk of breast cancer. Rather than simply looking at whether screening helps with early detection of breast cancer, the panel examined whether it leads to fewer deaths. The task force also was selective about the existing studies it reviewed, which could well have influenced the conclusions that were reached. If another group designed a slightly different analysis, the results might be different too.

Another criticism is that the recommendations are based on the use of film mammography, an older technology that is increasingly being replaced with digital mammography. If you read the task force’s clinical summary, however, it’s clear that both digital mammography and MRI imaging were reviewed for their effectiveness. The conclusion was that there’s insufficient evidence to show these two technologies are better overall at detecting cancer than film imaging. The task force noted that digital mammography appears to be "somewhat better" for younger women or women with dense breast tissue. MRI imaging appears to be more effective among women at higher risk of getting breast cancer. The down side: Both technologies are more expensive, and they’re more likely to lead to false positive findings and possibly overdiagnosis.

Other organizations are doing their own analysis of how the USPSTF reached its conclusions. No doubt we’ll be hearing more about this issue. None of this is etched in granite, after all, and our perspectives on the benefits of mammography will likely continue to evolve as more data are accumulated.

For what it’s worth, I don’t think the USPSTF deserves the bashing it has received over the new mammography guidelines. This is a nonpartisan group with considerable credibility. Its recommendations have generally been viewed as the gold standard in clinical practice. In many respects the panel is even conservative – careful to weigh the evidence and consider the existing science. Whether you agree with the panel’s conclusions or not, it took guts to ask important and tough questions about the benefits of screening for breast cancer. It’s safe to say we in the United States spend millions of dollars each year on mammograms – more than any other industrialized nation. As politically unpopular as it may sound, we need to be asking ourselves whether it has made us healthier or given us better outcomes.

Maybe this is part of the problem. Pointy-headed academic science has a way of colliding with real life. What we see and what we experience aren’t always explained by the statistics. The bell curve might illustrate the epidemiological probabilities but it doesn’t necessarily tell us how this is supposed to apply to individuals.

There’s a balance somewhere in here between being driven solely by the scientific evidence vs. being ruled by emotion and anecdote. I’m not sure where it is but we do need to find it and bring the discussion back to a more rational plane.

Rewriting the mammogram rules

The fallout from Monday’s news that mammograms are being recommended less often for women continues to spread far and wide. Reactions have spanned the gamut: confusion, suspicion about the motives behind the new recommended guidelines, and even outright anger.

To summarize, here’s the exact wording of the U.S. Preventive Services Task Force’s new guidelines:

The USPSTF recommends against routine screening mammography in women aged 40 to 49 years. The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient’s values regarding specific benefits and harms.

The USPSTF recommends biennial screening mammography for women aged 50 to 74 years.

The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of screening mammography in women 75 years or older.

The panel gives a "C" recommendation to mammography for women in their 40s, meaning that while there may be some benefit to individual patients, there is "at least a moderate certainty that the net benefit is small. Every-other-year mammograms for women ages 50 to 74 received a "B" recommendation, defined as "high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial."

Needless to say, this flies in the face of the messages women have been hearing for the past umpteen years about screening for breast cancer. The debate has been raging fast and furious, including right here on the West Central Tribune’s Web site.

"Better a false positive than a missed positive!" was one person’s opinion. Commenters called the recommendation "ludicrous" and "hogwash."

If there was ever any doubt that the public was paying heed to being screened for cancer, look no further. They’ve clearly gotten the message. There’s just one problem: The thinking behind the USPSTF’s new recommendations is more nuanced and less cut-and-dried than many people seem to believe.

First, this change is not all that new. There has been a back-and-forth debate for many years over the benefits of mammography screening for women in their 40s. The evidence that it’s clearly beneficial for the general population of women in this age group has never been particularly strong. This does not mean it’s worthless, especially when it comes to individual women and their own health history, circumstances and preferences. What it means is that the existing data don’t conclusively demonstrate that all women should be screened annually, starting at age 40, in order to improve the rate of early breast cancer diagnosis and decrease the number of deaths from breast cancer.

Second, no one is saying we should stop screening altogether or that we should withhold mammograms from women who really want them. The USPSTF’s own clinical summary for women in their 40s says it quite clearly: "Do not screen routinely. Individualize decision to begin biennial screening according to the patient’s context and values." (Emphasis added.)

I suspect what we’re seeing here is the beginning of a new overall approach to screening in general, one that is perhaps more balanced and more realistic about the relative harm vs. benefit than we’ve seen in the past. In fact, we saw hints of this last month already when the American Cancer Society stated the benefits of cancer screening have perhaps been overstated – then quickly backpedaled from its statement.

Experts in population health have long known there are limits to what screening can accomplish. This article, first published by Slate five years ago and reposted this week, demonstrates how this has been an ongoing debate:

Clearly, years of strong, scare-oriented public health messages, particularly with regard to breast cancer screening – "Don’t be a victim" and similar slogans – have gotten through to the public. The dogma that more is always better when it comes to cancer screening has taken hold, undiluted by any sense of screening’s drawbacks.

Yet there are drawbacks – ranging from the risk of false positives to the more complex issues of overdiagnosis and overtreatment. While early detection can certainly have benefits, it’s not true that screening can only help – and can’t hurt. Indeed, skeptics within the medical community, including the authors of the JAMA survey, have started to become more vocal in an effort to create a more balanced public view.

The operative words here are "public view." It has always been challenging for advocacy groups, such as the American Cancer Society, to educate a public that varies widely in its level of health literacy and receptiveness to the message. Simple messages – "get screened" – seem to work best but they unfortunately gloss over the complexities and tend to leave the public with information that’s incomplete or minus significant chunks of context. It’s no wonder, then, that people are confused and upset when they’re now hearing something that, to them, sounds different.

The New York Times talked this week to women and sifted through online comments, and found a fair amount of skepticism:

… Still there remains plain old confusion. Leslie Haltiner, a teacher’s aide in Denver, said she was uneasy with the idea of shifting her own approach to breast cancer detection based on new federal guidelines without first knowing the medical specifics behind them, and also what oncologists and breast cancer awareness groups were saying.

"Everything I’ve heard, from the health advertisements to the medical professionals, says that even if you don’t have a family history of breast cancer, it doesn’t mean you won’t get it," Ms. Haltiner said. "This sends a real confusing message. Wow, they’re doing a complete 180."

It’s also hard to take the emotion out of the issue. Almost everyone knows someone whose breast cancer was detected with mammography. Anecdotes can be so powerful that it’s easy to overlook the fact that the plural of "anecdote" is not "evidence."

What are we to make of a recommendation that comes from an organization described as a government panel? The U.S. Preventive Services Task Force falls under the umbrella of the Agency for Healthcare Research and Quality, itself an arm of the U.S. Department of Health and Human Services. The task force’s mandate is to "conduct scientific evidence reviews of a broad array of clinical preventive services, develop recommendations for the health care community, and provide ongoing administrative, research, technical and dissemination support."

Plenty of critics see the new mammography recommendation as a first step down the slippery slope of government-dictated rationing of care. Is this because the recommendation happens to come from a nonpartisan government panel (the members of whom, by the way, all work in the private sector)? It’s worth keeping in mind that organizations such as the American Cancer Society, which continues to call for annual mammograms for women in their 40s, are in the business of advocacy and will likely take a stance that’s consistent with this mission. It’s also worth pointing out that not all advocacy groups are in consensus on this issue; the National Breast Cancer Coalition backs the new USPSTF recommendations, as does the National Women’s Health Network.

As I read the news stories, the analyses and the online comments in reaction to these new evidence-based guidelines, the word that comes to mind most often is "disturbing." I’d like to think there is some support among American consumers for evidence-based medicine – that is, medical intervention that has been shown to be effective and to achieve the desired outcome, vs. simply offering intervention for the sake of offering something or because the patient wants it. I’d like to think we’re capable of considering the facts instead of reacting in emotional knee-jerk fashion.

Some commentators have already started to wonder whether the American public is truly on board with evidence-based care. Physician-blogger Dr. Kevin Pho thinks it may be a tougher sell than anyone realizes: "The thought that ‘more medicine is better testing’ is so pervasive in the mindset of the American public that it’s going to be extremely difficult to scale back testing in this country. Even if it’s the right thing to do." He followed up these thoughts with another post that explores what the backlash on breast cancer screening might mean for health care reform.

My guess is that most physicians, and most women, will probably stick with annual mammograms starting at age 40. Perhaps a minority of women will appreciate that they can skip the annual mammogram routine without being viewed as irresponsible or needlessly putting their health at risk. Maybe some day our thinking will shift more towards the evidence. But right now, I’m not sure physicians are ready to embrace the USPSTF’s new guidelines, and I don’t think the American public is ready for them either.

Update, Nov. 20: The New York Times analyzes how the debate over cancer screening has revealed a culture clash in medicine. The Everwell site takes a look at five of the top myths about breast cancer screening and the USPSTF’s recommendations. Gary Schwitzer, a blogger and journalism professor at the University of Minnesota, also provides a running commentary on how the mainstream media has been covering this issue.

West Central Tribune file photo by Bill Zimmer

To screen or not to screen

The message in a New York Times story earlier this week wasn’t one that the American public is accustomed to hearing: namely, that the benefits of cancer screening have been overstated and that even the American Cancer Society is rethinking its longtime advocacy of routine screening. It quoted Dr. Otis Brawley, chief medical officer of the American Cancer Society, as saying, "… I’m admitting that American medicine has overpromised when it comes to screening. The advantages to screening have been exaggerated."

It didn’t take long for the reaction to follow. One science journalist called it "a bombshell, if true."

The American Cancer Society issued a statement from Dr. Brawley the next day, clarifying its stance:

While the advantages of screening for some cancers have been overstated, there are advantages, especially in the case of breast, colon and cervical cancers. Mammography is effective – mammograms work and women should continue [to] get them…

The American Cancer Society stands by its recommendation that women age 40 and over should receive annual mammography, and women at high risk should talk with their doctors about when screening should begin based on their family history.

The bottom line is that mammography has helped avert deaths from breast cancer, and we can make more progress against the disease if more women age 40 and older get an annual mammogram.

Since 1997 the American Cancer Society has recommended that men talk to their doctor and make an informed decision about whether or not prostate cancer early detection testing is right for them. This recommendation also still stands.

Did the New York Times article get it wrong, then? No one has actually come right out and said so. Some observers have already labelled the whole thing as a controversy, while others are dissecting it more thoughtfully.

In truth, there are many nuances when it comes to weighing the pros and cons of screening and early detection for cancer, explains Dr. J. Leonard Lichtenfeld, deputy chief medical officer for the national office of the American Cancer Society. He blogged a response that outlines some of the complexities:

… Developing and accurately promoting guidelines are complex processes that don’t lend themselves to sound bite messaging. They are also a "living process" that requires continuing assessment of the evidence, and changing guidelines when the evidence warrants it. They are not written in stone for all time.

He adds that "different experts can look at the same data and come to different conclusions."

It’s confusing for the public, acknowledges the New York Times in a followup article:

While the limits of cancer screening have long been known in the prevention community, the debate is new and confusing to many patients who have been told repeatedly to undergo screening mammograms or annual blood tests to gauge prostate cancer risk.

"The health professions have played a role in oversimplifying and creating the stage for confusion," said Dr. Barnett S. Kramer, associate director for disease prevention at the National Institutes of Health. "It’s important to be clear to the public about what we know and be honest about what we don’t know."

Amid the fallout of this much-discussed news story, there’s a very real risk that many people will misunderstand, focus on only one portion of the message, or not get it at all. Overall, though, I don’t think it’s necessarily a bad thing that this discussion is taking place – and that the discussion is happening on a broader, more public stage. You could say in fact that it’s overdue. When we have a better understanding of the risks and benefits of screening, maybe we’ll be in a better position to accept its limitations and to make decisions that are more informed.

West Central Tribune file photo