Mass screening has been ‘sold’ to American consumers as the way to catch life threatening diseases in time. Mass screening has been sold as preventive care when in reality it is early detection. And, unlike prevention, mass screening has its benefits and its risks.
Gilbert Welch, MD, author of Should I Be Tested for Cancer, Maybe Not and Here’s Why, roiled the conventional medical community, the media, and the American public by presenting the fact that science fails to back up mass cancer screening. Dr. Welch takes on the PSA blood test to screen for prostate cancer, mammography for breast cancer, colonoscopy for colon cancer, among other screenings presenting in easy-to-understand language that for those with a family history or genetic predisposition and risky lifestyle habits screening may make sense. For others, not only are you risking the cost of screening but you risk the dangers of screening. These dangers include false positives, false negatives, and unnecessary intervention for abnormalities that may never develop into cancer.
Now, a published study termed to be “definitive” of more than 78000 women over 18 years finds that screening healthy women for ovarian cancer may have more risks than benefits. While ovarian cancer is one of the most deadly and the most feared malignancies, using ultrasound and the CA 125 blood test as screening tests did not result in women living longer. In fact, those screened died at the exact same rate as those not screened. The combination of these two tests often produced false positives, that is, alarm when none existed. At the study’s end, it was determined that 3300 women had unnecessary surgery and 166 developed complications from that surgery. Every surgery comes with risks as does the anesthesia used during the surgery. The study, paid for by the National Cancer Institute, was released at the annual meeting of the American Society of Clinical Oncology.
While the study ended with the traditional “we need more money for more studies”, it is clear that a different approach than mass screening is needed to affect how long women live who are at risk of ovarian cancer. Too often, doctors fail to acknowledge the power of lifestyle as a powerful tool to affect genetic predisposition. That is, science clearly confirms that genes are turned on and turned off by lifestyle factors. These include chemicals found in food packaging, water, pesticides, lawn sprays, personal care and home cleaning products, as well as a myriad of other sources, laughter, nutrients like antioxidants and phytochemicals or the lack of them in our diet, fats like the good fats found in cold water fish and vegetables like flax, exercise, and nearly every aspect of our daily lives. For example, Japanese research demonstrated 26 different genes that control blood sugar were inactivated by watching funny videos and comedy for two days vs. the control group who listened to dry boring lectures and were unable to control blood sugar.
New research indicates that over half of cancer are affected by our environment. That is a powerful incentive to take control of our daily lifestyle choices channeling them to inactivate genes that predispose us to diseases including cancer, diabetes, inflammatory diseases like Alzheimer’s and heart disease, just to name a few. Books like Jeffrey Bland, PhD’s Genetic Nutritioneering educate us and our practitioners that once we know our unique genetic map we can tailor our daily lifestyle habits and choices to affect those genes, inactivating those that predispose us, for example, to inflammation that may increase our risk of diseases like colitis and Alzheimer’s.
However, medical school education, clinical practice guidelines, drug company advertising influence, and doctors in clinical practice fail to emphasize, educate, and encourage consumers to use these tools to prevent diseases that may run in their families or diseases for which their lifestyle may put them at risk. Consider the recent front page headlines that we have a drug to prevent diabetes; and it is Avandia. Of course, we later learned the risks of Avandia outweighed the benefits. But, reading further we learned Avandia could help prevent diabetes up to 47% of the time. No reference was made to the lifestyle choices verified by Harvard School of Public Health research that confirmed up to 90% of all diabetes could be prevented or reversed by a series of lifestyle choices.
This is an area of potential American innovation for true health care reform. Let’s not let the voices of vested interests drown out the fact that much of our health is within our control. We can make a positive or negative difference each and every day. The choice is yours. Let’s make sure the incentives are there because as we all as know “it’s just too expensive to be sick”.
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Interesting article….thanks. Would you please send me, or better still, add a post script to this article on where the information on the Japanese reasearch study may be found?
Somehow along the way, prevention got translated into always be testing. If you really want to cut your risk, you have to live a healthier lifestyle. Plain and simple.
Too bad not many are listening.
Outstanding commentary. As a medical oncologist, fully aware of the human life at stake, yet I think that “screening” is often more hype than benefit when you actually look at the data. It is true also for a lot of the “surveillance”imaging studies that are used to “follow” someone whose cancer has gone into remission. It should be remembered that the radiation exposure from a single CT of chest is equivalent to 400 chest xrays, yet patients often go through 3-4 per year in the name of tumor surveillance. The long term benefits of “finding” a tumor before it causes symptoms and prompts such a study are unproven and, too often, such studies do not even actually impact treatment decisions for the majority of people getting them. Doctors and patients should ask themselves: “How will study alter treatment decision?” before ordering or consenting to study. The long term effects of having 1200- 1600 chest xrays per year remain unknown. THank you for keeping us posted on things that Washington and Big Pharma are up to to curtail our ability to take responsibility for our own health.
Nice to finally have a Dr. respond to an article and makes sense. I have decided to forgo Mammograms. I am 57 and feel that the radiation is not worth the risk with no family history.
Dr. Lowenthal – Wrong about the studies regarding the value of serial irradiations. Life Extension Foundation (www.lef.org) published an extensive series of articles in their magazine, “Life Extension”, on the problems associated with any and all x-rays when there are either few or no reasons except giving the radiologist practice.
As a chiropractor what I learned made me decide to find alternate means to learn exactly where and how to fix my patients. Low and behold, I got that and a lot more, too. There’s always somebody with a better mousetrap.
Thank you for being a voice of common sense in a dumbed-down crazy world of vested interests.
People are somewhat gulilble. Today they want us to believe this all necessary. The doctors, the makers of all this equipment and the drug companies want us believe all this is good for us. We as the ones that pay for all of this, need to do our homework and to beware of these big monopolies. Always check for more then one opinion and research,
Thank you for this. Too often, detection is not prevention. It benefits the medical equipment industry more than the person receiving the test. In my personal case, despite a series of colonoscopies, colon cancer was never found in either my brother or my mother until it was at a late stage. On the other hand, my breast cancer was discovered through a routine mammography. An oncologist who has been practicing for over 25 years in Paris, Professor Dominique Belpomme, noticed that despite early detection and cancer treatment, the mortality rate for cancer remained the same and that cancer rates were rising. He believes that about 75% of cancers are of environmental origin and is now researching the link between disease and environment, through his own association ARTAC ( http://www.artac.info ) and recent establishment of a European research institute in Brussels, independent of industry’s financing and influence.
Many of us spend very little time thinking about how we can improve either physically or mentally. If we tried to optimize ourselves with good exercise, supplements and a good diet, on the way to improved performance, we would all but inevitably reduce our risk for the major diseases that plague modern society.
Not only is the fundamental idea behind “an ounce of prevention is worth a pound of cure” right on target, much of what we should do to prevent disease would enhance our lives whether or not we were fated to have a major disease without the interventions.
My family has weight issues that I have been able to aviod with vigorous exercise. What’s interesting is that they don’t have the diseases that most people do who carry extra weight. They are not on medications or anything. I believe this is because we eat a healthful diet (over eat in some cases.) None of us gets sick all that often and least of all me in my opinion due to using multivitamins (and not grocery store bought.) The fact that we don’t take any meds (except my Mom who is almost 70 and only takes 2,) amazes a lot of people. I hope that my life can be a testimony to the power of a healthy lifestyle!!!