Spectator Health

Time for a new, patient-driven approach to cancer screening?

30 July 2014

No screening test for cancer is 100 per cent accurate. While some individuals might benefit from having an early cancer spotted, many more will have abnormalities detected that, although suggestive of a cancer, turn out after further investigations to be completely innocuous. Such false-positives have led to concerns that cancer screening can result in psychological and physical harm to patients.

Nowadays, although routine NHS screening is available for certain cancers such as breast, cervix and bowel, the worry about false positives has been a key argument limiting access to CA125 testing for ovarian cancer and CA19-9 testing for pancreatic cancer.

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Lung cancer screening is now advocated for certain groups of patients in the USA. However, the debate in the UK about embarking on such screening has not only focused on the risk of false positives but also that low dose CT scanning will detect other abnormalities — known as incidental findings — including cysts in the kidney or arterial swellings (aneurysms).
Traditionally many doctors have adopted a somewhat paternalistic approach to cancer screening. Back in the early 1970s the terms ‘Ulysses syndrome’ was even coined for those individuals traumatised by their journey around the health care system following a false positive result. Unfortunately little research has actually focused on the real — as opposed to perceived — impacts on patients of false positive and incidental findings in the context of a well organised cancer screening programme. Moreover it is important to appreciate that there is also sound evidence that CA125, Ca19-9 and low dose CT scanning can, in some circumstances, detect cancers at an earlier — and potentially curable — stage.

In a study published this week in the journal Cancer, Ilana Gareen and her colleagues assessed patients’ wellbeing after lung cancer screening. Interestingly they found that individuals receiving a false-positive or incidental finding screen result experienced no significant increase in anxiety or reduction in quality of life compared to those given a negative result at the outset. Perhaps the time is ripe to look afresh — and from the patient`s perspective — at the screening options available for lung, ovarian and pancreatic cancer?

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  • Binding&Hoche

    The ‘experts’ at the King’s Fund who drive NHS policy making now blame the entire NHS shortfall on ‘the ageing population’ . There’s little point in practising medicine at all now Rabbi Neuberger’s ‘TLC – LCP’ brigade have taken over – so why bother screening at all? In fact, why bother treating anything? Just have suicide booths in Lloyds Pharmacies and have done with it Mrs. N.

  • Aberrant_Apostrophe

    Given the title of the article, did I miss the bit where the patient actually drives the screening process? All it seems to talk about is how most patients who receive false positive results don’t go all do-lally, which I think most of us know already – despite a few recent cases reported in the Daily Mail. I was at the very least expecting a discussion of how difficult it can be for patients who are ‘statistically unlikely to have a particular cancer’ to convince the medical profession that do actually have it. As my GP often says to me ‘You know your own body better than any doctor does’.

    • rtj1211

      Unfortunately the financial reality is that doctors have to play the statistical odds and some will slip through the net. Diagnostics are, after all, only as good as the diagnostic, and with cancer, the reality is that not all early stage cancers show identical aberrant markers.

      The difficulty is that if science hasn’t yet found a cheap way to diagnose all early stage disease, you can only detect the ones that fit the parameters of the tests available. For example, there are actually far better markers for Prostate Cancer than PSA out there, but PSA is the one which has proven itself in the field to date, so that is what you get. Maybe in 10 years there will be a range of diagnostics out there but to date, they aren’t licensed for use.

      You may find it easier to get a clinician engaged in early disease detection research to take you seriously – after all, even if you don’t have disease, you can be one of the ‘controls’. Even then, you have to fit the parameters of the trials concerned. So you may, if you are unlucky, not get picked up there either.

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