The American Cancer Society warned Wednesday that premature screening could lead to overtreating or overlooking cancer. Gwen Ifill reports.
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The message has often been a simple one: Screening for cancer saves lives. But that message has masked a growing debate over whether screening offers risks of its own, including too many diagnoses and overtreatment.
Now today, a new article in "The Journal of the American Medical Association." Researchers looking at two decades' worth of screening for breast and prostate cancer conclude that, though beneficial, screening is not always a guard against later-stage cancers.
Here to sort through the questions these conclusions raise are the paper's lead author, Dr. Laura Esserman, a breast surgeon and director of the creast care center at the University of California San Francisco Medical Center, and Dr. Victor Vogel, vice president of research for the American Cancer Society.
Welcome to you, both.
Dr. Vogel, I will start with you. It sounds like Dr. Esserman is still trying to get her audio.
So, I want to start with you anyway, because the question this raises was — I guess, exacerbated this debate that has been going on by comments made by the American Cancer Society to "The New York Times" about whether or not screening is being overdone. So, what's your answer to the question of whether there is too much screening going on?
DR. VICTOR VOGEL, vice president of research, American Cancer Society: Well, we don't believe, at the American Cancer Society, Gwen, that there is too much screening going on.
But we are starting to have discussions about the real scientific benefits and merits of screening. And we are now recognizing, along with the scientific community, that screening is not perfect. Now, on the other hand, we know that screening saves lives, so we don't want people to stop doing it. But we're continually reexamining the science, looking at the evidence, and always doing research to find better methods of screening.
Dr. Esserman, I think you're with us now.
Give us a sense of the pros and cons of getting this — all this early screening, which has now become so much the watchword of how we take care of ourselves.
DR. LAURA ESSERMAN:
I think the message has to be clear, that screening has limitations.
And I think if we understand what it can do and it can't do, then we have the opportunity to make it better.
I think the message is that, after 25 years of screening for both breast and prostate cancer, we have increased the number of cancers that we have detected. Most of these cancers have been early cancers. While that, on the surface, seems good, one of the problems is that we haven't seen a commensurate decline in the number of later-stage cancers.
So, that tells us there's a problem. The problem is that we are detecting early cancers that may not become life-threatening or may not be particularly aggressive, and that can lead us to overtreatment. And, at the same time, we're not necessarily catching the people who are at risk for the most serious cancers.
So, I think the message is that people have to understand what screening can do. And we have to be careful to try and figure out how we can improve screening and how we can tailor it and personalize it, do less screening in groups of women who may not benefit or who — where there is no evidence of benefit, and there may only be harm — and that's women over 70 or 75 — and more screening for the women who we think might be at risk for the most serious cancers.