September 2016
More on Screening

As with PSA screening, neither screening for breast cancer nor screening for colon cancer has been shown to reduce overall mortality; and both programs are hugely expensive. Yes, screening for breast cancer reduces breast cancer mortality because it finds lots of breast cancers that would not have killed the patient, and we treat and “cure” these incidental cancers killing some women in the process. But the truly dangerous breast cancers arise and spread out of the breast in a few months, so we would need mammography every 2 to 3 months to detect and treat such aggressive cancers.

Nevertheless, the breast cancer lobby opposes any recommendation to reduce the screening program and shift that money that is wasted on screening to some other area of medicine where it could provide more benefit. For example, it opposes the recommendation of the U.S. Preventative Services Task Force to begin screening at age 50 instead of age 40, and in this it is supported by hospitals, radiologists and gynecologists - all those who would be adversely impacted financially. It was the breast cancer lobby that forced insurance companies in the 1990’s to pay for an expensive experimental program of high dose chemotherapy followed by bone marrow transplant to treat breast cancer. The program was finally abandoned in 2001 once real studies on it came out which showed that it did not work as compared to conventional treatment. In the meantime though, thousands of women were subjected to this gruesome regimen that made their last days on earth a living hell. Unfortunately, this fiasco did not undermine the influence of the breast cancer lobby.

Colon cancer screening has two special problems. In the first place, the screening method of choice – colonoscopy – is very invasive and sometimes deadly. Colon perforation rates vary greatly, but nationally about one of every two thousand colonoscopies result in perforation. In medical school I was taught that a screening test should not be invasive because the general population will resist the screening; but that principle has been abandoned for reasons you can guess. Sadly, in modern medicine as it has developed, to understand how things work you have to follow the money.

The second problem with colon cancer screening is that less than 5% of us will be diagnosed with colon cancer. Moreover, the great majority of those who die of colon cancer are retirees. So our policy is to commit large sums of precious health care dollars not to preventing disease in the young, but to detecting and treating disease in the old. This policy is lucrative for the health care industry, and bankrupting for the society. Countries that take the opposite approach (such as Sweden, Switzerland and Japan) not only spend less on healthcare but have longer average lifespans, better maternal mortality rates and better infant mortality rates than the U.S.