The cliché “it’s better to be safe than sorry” no longer holds true when it comes to cancer screening.
The newest strategy for getting checked up is literally called “wait and see.” It casts aside the idea that more caution equals better outcome, and instead operates on the fact that a lot of times we get things wrong.
In October, which was Breast Cancer Awareness Month, the American Cancer Society released a statement recommending that women start getting mammograms at 45 instead of 40, and that they skip routine manual checks altogether. This did not come without heavy backlash from breast cancer survivors, doctors and even the average layperson with the slightest bit of common sense. When it comes to cancer detection — something we know so little about — taking away even the slightest edge we have seems nonsensical.
In the same vein and around that same time in October, The Wall Street Journal released an article discussing treatment of thyroid, prostate and breast cancers. It cites many times where treatment in the early stages of these cancers caused more harm than good, and suggests that as medicine becomes more sophisticated, we might lean towards less aggressive regimens. “Active surveillance,” rather, might be the preferred choice of action. Instead of jumping right to surgery or intense drug therapy, doctors are instead just carefully monitoring small malignancies through tests and check-ups. If the cancer isn’t likely to grow or spread, why undergo a surgery with a long recovery time and list of complications to follow?
Michael Misialek, associate chair of pathology at Newton-Wellesley Hospital, said his Friday letter to The Boston Globe: “I urge patients to view the news as a learning opportunity.” His article focuses specifically on prostate cancer screening, and notes the “sharp decline” in screening and diagnosis in recent years. Specifically, he discusses whether this is good or bad news. He encourages active surveillance, and basically says the appropriate level of action is determined on a case-by-case basis, through doctor-patient collaboration.
Now more than ever, patient involvement is becoming a huge part of the journey from screening to treatment. Almost every news source that has reported on the cancer screening debate, and every op-ed piece that offers an opinion, scratches at the surface of this idea. As Misialek said, the news media offers a lot of up-to-date information on the medical world — so much so that the public is almost as informed as the doctors. As the WSJ noted, doctors are now giving their patients more of a choice: “to treat or not treat.” The closing paragraph of a Nov. 25 editorial from The New York Times advises patients to “explore the options thoroughly” no matter what. A Nov. 24 opinion piece in The Times-Tribune suggests, “maybe patients should have a choice about how hard doctors look. Cancer screening is not just about science, it’s also about value judgments.”
This not only puts a lot more decision making in the hands of the person without a medical degree, but also adds a lot more pressure. Whether you wear a white lab coat or not, it’s important for you to be informed on new cancer guidelines and ideas for your own sake.
