risk assessment


Cancer Revisited: Our Evolving Thinking, And Where’s The Cure?

Cancer — and our evolving knowledge about its nuances and complexity — is in the news this week, three decades after the so-called War On Cancer began.

A highly publicized piece in The Journal of the American Medical Association earlier this week that addresses cancer overdiagnosis and overtreatment begins by charting some failures:

Tara, a cancer patient at San Francisco's Henna Lounge, who helped inspire "Henna Heals"(Henna: Henna Lounge; Model: Tara; Photography by: Frances Darwin)

Tara, a cancer patient at San Francisco’s Henna Lounge, who helped inspire “Henna Heals”(Henna: Henna Lounge; Model: Tara; Photography by: Frances Darwin)

Over the past 30 years, awareness and screening have led to an emphasis on early diagnosis of cancer. Although the goals of these efforts were to reduce the rate of late-stage disease and decrease cancer mortality, secular trends and clinical trials suggest that these goals have not been met; national data demonstrate significant increases in early-stage disease, without a proportional decline in later-stage disease. What has emerged has been an appreciation of the complexity of the pathologic condition called cancer. Continue reading

A Prostate Screening Picture Worth A Thousand Words

Prostate cancer early detection

The Max Planck Institute for Human Development has just kindly given us permission to post this excellent chart depicting the effects of prostate screening on men over 50. It goes with this post from yesterday — Analyzing those widespread feelings of ‘Hands off my PSA test‘ — and illustrates the reasoning behind recent recommendations against routine prostate screening for healthy men.

I love the feeling of dawning clarity as my eye passes slowly over the data and the point comes across: Hmmm, 1,000 men in each group. With prostate screening, the same number of men die of prostate cancer as without screening (red circles with a P inside). But with screening, a couple of hundred get “false positives” that worry them but turn out okay. And 20 are treated unnecessarily for prostate cancer, with all the downsides of the treatment, to no benefit (blue circles with an X inside). Okay, I think I get it now…

A couple of points from the folks at the Max Planck Institute: Continue reading