“For every cancer averted, numerous individuals receive a cancer diagnosis they would not have experienced if they had not been screened,” they explained, adding that with more “survivors” who avoid overdiagnosis disease through screening, screening gets only more popular.
In addition, Dr Adami and colleagues suggested that population screening programs also can cause harm. Whether or not the cancer is an “overdiagnosis”, any cancer diagnosis “causes severe, stress-induced psychiatric and somatic outcomes for patients,” they wrote.
“Early detection screening in urology has played an enormous role since 1991 when the PSA test was commercially introduced,” Dr Joshi said. “Prostate cancer is the elephant in the room.”
Since the early 90s, evidence of a benefit of PSA-testing on a large scale is lacking, Dr Adami and colleagues wrote, leading the US Preventive Services Task Force to leave it to physicians and patients to decide whether to use the method.
In cases like this, the solution, according to the editorial, is the deimplementation of early detection screening at a population level, or a shift to narrow recommended age ranges and increase screening frequency intervals.
“There is a trend in the minds of many to throw the baby out with the bath water — because these tests are not useful in some patients, let’s throw the whole test out,” Dr Joshi said. “However, that discounts the idea of active surveillance, which has been pioneered in prostate cancer and with small renal masses.”
A third option to lessen the use of population-wide early detection screening would be to focus more on shared decision making, Dr Adami and colleagues noted.
This would be much easier said than done, though, commented Dr Joshi. Physicians can discuss the idea of shared decision making with a patient, or discuss the harms of screening, but when a patient knows of a friend or family member who credits screening with saving their lives, it will be hard to talk that patient out of screening, he said.
The most important thing, Dr Adami and colleagues wrote, is “to be honest to ourselves and to our patients about what screening can achieve and what (mostly) it cannot achieve.”
- Adami HO, Kalager M, Valdimarsdottir U, et al. Time to abandon early detection cancer screening [published online December 19, 2018]. Eur J Clin Invest. doi: 10.1111/eci.13062