An Interesting Take on Cancer Screening
A-Z Challenge letter: S – Screening
A little while ago, I read an article by a GP, Dr Margaret McCartney, explaining why she had decided not to take part in screening for cervical cancer. She’s also decided against a mammogram when she is invited, and isn’t convinced about the benefits of screening for bowel cancer.
That’s not to say that she thinks screening is a waste of time, but that she doesn’t agree with screening as par for the course. People with symptoms of illness don’t need screening, for example, they need investigations to find the problem – screening is for people who are not showing any signs of illness. And she’s not convinced it’s always worth the effort:
Cervical screening does prevent deaths from cervical cancer. But to get that reduction, you have to follow up and/or treat all the women who have cell changes on their screening test. However, most cervical-cell changes found at screening will not lead to cervical cancer. The problem is we can’t predict which will, so all need further monitoring or treatment. A study from Bristol in 2003 found that 1,000 women have to be screened for 35 years to prevent one death from cervical cancer; and to prevent that death, 80 women have to have further investigation, with 50 women having treatment to their cervices. Four out of five women found at screening to have “high-grade” changes in their cervix did not go on to develop invasive cancer.
She also talks of the fact that rarely are the risks associated with screening and the follow up treatments made clear. Nor is the fact that screening is completely optional. If you’ve ever missed a smear test, you’ll no doubt have had a raft or reminder letters through your letterbox telling you to book one soon. But there’s no mention of your right to opt not to have one.
Research has shown that when people are made aware of the pros and cons of screening, rather than just the pros, fewer people are prepared to put themselves through the tests. Clearly, some people are more at risk of developing cancer than others, but for people who are low risk to start with, screening offers far fewer benefits than we are led to believe, Dr McCartney argues.
I’d love to know your thoughts on this.