People are afraid of cancer. I don’t think this will come as a surprise to anyone, but what might come as a surprise is that our fears often make our health worse. I’m not referring to some fear induces poor health concept. Rather, our fear leads to health decisions that are not rational.
This is a regular thought of mine, brought on recently by the hysteria over the recommendations of the U.S. preventative screening task force that men over 75 do not get screened for prostate cancer. The details of the panel’s recommendation can be read here, but the particularly relevant elements can be summarized as:
- Prostate cancer screenings by measuring prostate specific antigen (PSA) lead to followup tests and treatments.
- The followup tests and treatments are very bad for you. How bad? Incontinence, bowel disorders, loss of sexual function, and dropping dead from anaesthesia during surgery are all side effects that rise to the top of the list.
- We can say with statistical certainty that the benefits of PSA screening do not justify the extreme burden of the side effects of followup treatment.
So what then of all the stories of prostate cancer survivors? Stories abound about PSA screenings detecting cancer before any symptoms appeared thereby allowing a life to be saved. There’s a clear, if unpopular, response to prostate cancer “survivors”:
You are not a cancer survivor.
Rather, you had cancer. You had it treated. You endured horrible side effects. If you never had the PSA test, never found cancer, never had it treated, and never endured the side effects of your treatments, then you would’ve died of something else. That might make you a victim of a flawed medical system, but it doesn’t make you a survivor.
That’s harsh you say. Probably. It’s impolite at the least. But it is statistically accurate, and statistics is not a field known for being fluffy and cuddly. It’s known as a field that can give us with certainty the best course of action in medicine. That course of action is to not get screened for prostate cancer.