Health Warning: Screenings May Be Dangerous

[Guest guest]

Comments?

Misty L. Trepke

http://www..com

 

Health warning: screening can seriously damage patients

 

See my earlier article

<http://www.newmediaexplorer.org/chris/2003/06/10/the_depths_of_decei

t_mammography.htm>The

Depths of Deceit Mammography for some salient background.

Particularly the effects of X-Rays.

 

<http://www.newmediaexplorer.org/chris/>Chris

<http://www.newmediaexplorer.org/chris/>Gupta

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A story about cancer screening - they seem to finally recognize

that something's not right about their approach. The numbers tell.

 

<http://www.newmediaexplorer.org/sepp/index.htm>Josef

 

Health warning: screening can seriously damage patients Breast

cancer checks at centre of fresh controversy as concerns grow that

hi-tech clinics may harm those seeking to pre-empt illness By Jeremy

Laurance, Health Editor 11 July 2003

 

Hi-tech screening services, which promise to detect early signs of

heart disease, cancer and other conditions while they can still be

cured, are being introduced in Britain despite warnings from doctors

that they may do more harm than good.

 

A new allegation that breast screening, one of the longest

established procedures, is being over-promoted to women who are not

being alerted to the harm that can result is published today in the

British Medical Journal.

 

Regular mammography to check for breast cancer is an established

technology, backed by scientific expertise, which is popular with

patients.

 

But debate continues to rage over whether it saves lives or prompts

unnecessary treatment. Hazel Thornton, a former breast cancer

patient and visiting fellow at the University of Leicester, and

Michael Baum, emeritus professor of surgery at University College,

London, and a long-time critic of screening, have teamed up with a

colleague to demand information for women that sets out the risks

and benefits.

 

They cite evidence showing 1,200 women would have to be screened for

14 years to save one life from breast cancer while during that time

scores would suffer anxiety, surgery and mastectomies for suspicious

lumps that turned out to be benign.

 

The war over the risks and benefits of screening is likely to grow.

Clinics offering whole body scans, diagnostic tests and checks for

specific conditions such as skin cancer are springing up in London

and in other cities promising to provide clients with the " ultimate

health check " .

 

At least four clinics have opened in the capital in the past three

months offering tests lasting from 15 minutes to two hours and

costing up to £1,000. Companies say the tests can reveal small

tumours, aortic aneurysms (defects in the wall of the main blood

vessel), bone erosion, artery deposits and osteoporosis (bone

thinning).

 

Whole body screening is big business in America. Smart walk-in

facilities such as the Ameriscan Body Imaging Centre are based in

shopping malls and on high streets and are heavily advertised. They

promise an ultra-fast image of vital internal organs for a price of

about £650.

 

The selling point of the scans is summarised in one company's

slogan: " You don't know what's inside until you look. "

Traditionally, doctors have performed health checks using the

thermometer, the stethoscope and their skill as diagnosticians. Now

the promise is that new technology will replace the application of a

sensitive touch and a listening ear.

 

But British experts are sceptical. Richard Smith, editor of the

British Medical Journal, said a whole body scan had become a

fashionable gift in the US for people reaching milestone birthdays

of 50, 60 or even 40. " You might be giving your loved one the

supreme gift of extra years of life. Unfortunately, you may be more

likely to give him or her a lorry load of anxiety and a series of

invasive, painful and unnecessary investigations, " he wrote.

 

The problem is that most scans throw up " abnormalities " but to

distinguish those that are benign from those that indicate serious

disease is often difficult. Dr Harvey Eisenberg, who runs a scanning

service in Newport, California, said he referred 80 per cent of the

clients he screened for further hospital checks.

 

" Emerging pathologies are almost always present. In 25,000 patients

I have seen maybe 10 that were completely normal, " he said.

 

Screening may wrongly indicate the presence of disease in some

patients

-

the " false positive " findings - causing them to have painful and

unnecessary investigations. An American patient who had a nodule

detected on his lung in screening described how he had a lung biopsy

to check for cancer, which revealed that the nodule was a healed

scar that was non-threatening. The investigation led to him spending

four days in hospital, enduring a painful procedure followed by

several weeks' recuperation and left him with a bill of $47,000

(£30,000).

 

Stephen Swenson, professor of radiology at the Mayo Clinic,

Rochester, Minnesota, said in the BMJ that screening for lung cancer

at his clinic as part of a study had detected 56 cases of the

disease over four years. " One could ask why screening should not be

advocated. Several uncertainties, however, make it premature to

advocate screening on a large scale, " he said.

 

Although they found more early-stage lung cancers, what was unclear

was whether this would delay progression of the disease, even with

treatment, or whether the mortality associated with treating lesions

which might turn out to be benign outweighed the gain from

screening. Professor Swenson writes:

 

" Some of the best doctors in the world have sincere differences of

opinion about such screening .... If patients simply want to get

scanned ... doctors should tell patients in explicit terms that such

screening has no proved benefit and that serious risks could

outweigh benefits (if there are any). Patients should understand

that the stakes are high. "

 

In their paper on breast screening in today's BMJ, Ms Thornton and

Professor Baum say misconceptions on screening abound. Many people

wrongly believe screening reduces the incidence of breast cancer,

that all types of breast cancer progress and that early detection is

always a benefit.

 

In fact, they say, screening contributes to a rise in the incidence

of breast cancer and one in five cancers detected is ductal

carcinoma in situ (DCIS), a type of breast cancer that may not

progress. In 40 per cent of cases, DCIS results in a mastectomy,

which may be unnecessary for the woman and expensive for the NHS.

 

They claim there has been " negligible improvement " in NHS screening

leaflets because of the tension that exists with the screening

service's need to boost uptake.

 

They conclude: " It is unacceptable that women taking tests continue

to suffer damage and regret because they found out the harms of

screening from experience. Unless women are able to make true

informed choices, funding for the service will continue to be

questioned. "

 

A spokeswoman for the NHS Breast Screening Service said leaflets

given to women were revised in 2001 to provide balanced information

on benefits and limitations. " All women receive a copy of the

leaflet with their invitation to screening which sets out what

screening can and cannot do, " she said.

 

Even the longest established form of screening in the UK - for

cervical cancer - is not immune to criticism. In a separate survey

in the BMJ, Angela Raffle, consultant in public health medicine in

Avon, and colleagues, calculated that 1,000 women would have to be

screened for 35 years to prevent one death. They point out that more

than 80 per cent of abnormal findings at cervical screening do not

progress to invasive cancer.

 

" The same may well apply in other organs and the prophylactic

[preventive] removal of colons, ovaries, breasts and gullets may be

killing people without benefit, " they say.

 

The rationale for screening - that we can nip diseases in the bud -

is now being adopted by companies to make fat profits. But

abnormalities are more common and difficult to interpret than people

think. Early detection can improve survival - but it may also mean

merely that patients spend more of their life with the knowledge

that they have a fatal disease. Sometimes it is better not to know.

 

Screening tests

 

Cervix

 

Examining a scraping of cells from the cervix under a microscope can

reveal early changes, which may progress to cancer.

 

Breast

 

Mammography (an X-ray of the breast) can detect lumps in the breast

that may be cancerous while they are too small to be felt.

 

Heart

 

Blood tests measure cholesterol levels and ECG can measure the heart

rhythm. The ultimate test is angiography, in which X-rays of the

coronary arteries are taken after being injected with a radio-opaque

dye.

 

Bowel

 

Testing faeces for the presence of occult (hidden) blood can detect

signs of cancer. An internal examination using a flexible telescope

can check for polyps, small growths from the intestinal wall, which

may develop into cancer.

 

Ovary

 

An ultrasound probe inserted in the vagina or pressed over the

abdomen, combined with blood tests, may provide early warning of

cancer. Trials are being run to establish its reliability.

 

Prostate

 

Blood tests, with rectal examination, may indicate cancer.

 

Lung

 

A scan can detect nodules that may be early tumours.

 

Bone

 

A bone density scan can provide early warning of the bone-thinning

disease osteoporosis, caused by loss of calcium.

 

The Independent

11 July 2003 09:36

 

http://www.newmediaexplorer.org/chris/2003/07/12/health_warning_scree

ning_can_seriously_damage_patients.htm