We’ve lost control of the screening agenda in cancer. As Balthus commented about modern art, in an effort to be all things to all people we’ve confused the messages so much that the public is wondering whether it’s anything to anyone. The propaganda on the merits of breast cancer screening continues unabated but the challenges to the prevailing dogma are coming in thick and fast.
The respective camps are entrenched and frankly it feels a bit like the Western front, with a few meters of territorial gain being applauded as some sort of major strategic victory. So any answer that isn’t a positive one for breast cancer screening simply will not be acceptable. And it’s not only breast cancer we have to worry about. The US Preventive Services Task Force (USPSTF) has now recommended against PSA screening for prostate cancer.
While many commentators applauded the insight and diligence at reaching this conclusion a serious majority were incandescent. Not only will this prematurely kill men but it will also dramatically increase healthcare costs for prostate cancer they cried! This interesting (mis) use of health economics is, it seems an increasingly deployed weapon against in all sorts of cancer policy areas.
So what are men supposed to think? The truth is that PSA screening doesn’t work but outside the ‘magic circle’ one could easily be forgiven for not knowing this. But the USA is not alone in this screening insanity. Despite absolutely no evidence Germany has a nationwide screening program for skin cancer despite a recent publication admitting they have no evidence it saves lives (Archives of Dermatology, online May 21, 2012).
The problem is we confuse the message. We want people to prevent and present early; don’t ignore symptoms that don’t go away. Yet we’ve wrapped up complex public health issues like screening and healthcare driven early detection into this mix. Even worse we use screening programs as Trojan horses in an attempt to engineer care pathways. It’s a flagrant misuse of public health policy. No wonder everyone is so confused.