Posts Tagged ‘Len Lichtenfeld’

JUNE 2; AQP: First there was surgery, then chemotherapy and radiation. Now, doctors have overcome 30 years of false starts and found success with a fourth way to fight cancer: using the body’s natural defender, the immune system. READ MORE>

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MAY 14: READERS DIGEST:  The following is the full text of an angry letter from the American Cancer Society sent to Reader’s Digest following an article it ran on prostate cancer screening in April. READ MORE>

Your article, “Cancer Screening: Doing More Harm than Good” (April 2009), lacked a sense of balance and honest commentary that would help inform your readers rather than frighten them. You’ve left your readers without a truly informed viewpoint on the issues of cancer screening, the science and the facts.

To say that those of us engaged daily in the fight against cancer are not aware that we will pick up cancers that would never cause a problem, or that there may be harms from the biopsies and treatment for cancer is a profound misrepresentation of what we know and what we recommend for cancer screening. We think about those issues every day. We talk about them, we argue about them, we write about them.

We believe that the scientific evidence shows that mammograms save lives and that colorectal cancer screening saves lives, and could save a lot more if we had more people screened. We believe the Pap test has been incredibly successful in reducing deaths from cervical cancer in the United States and other developed countries.

The fact is we don’t know who is going to get cancer and who is not. We don’t know which cancers are potentially lethal and which are not. We don’t know which cancers are going to be impacted in a good way by being found early and which are not. The reason we accept the risks of over diagnosis and treatment is that we believe the evidence shows that these screening procedures—when applied to large numbers of men and women—do save lives.

But, we are not blind to the questions that must be raised and must be answered before a population-based recommendation is made. When the American Cancer Society makes recommendations for the prevention and early detection of cancer, we have to consider what is the best course of action that applies to hundreds of millions of people.

We recognize very clearly that when we don’t have the evidence that screening works, we must say so. Such is the case with prostate cancer screening, where we say routine screening is not warranted, and clearly advocate that men have a discussion with their doctors or other health care professionals to discuss the pros and cons of prostate cancer screening before deciding whether to get tested.

If I seem a bit angry and perturbed about this debate, it’s because I have been around long enough to remember what life was like in the 1960’s and 1970’s before we had any of this evidence about screening. I remember what we meant by “early” breast cancer in the days before effective mammograms were available.

I remember women walking into the emergency department with towels wrapped around their breasts, bleeding from a mass or having discharge from the nipple.  There was no screening, and living five years for many of these women was considered a miracle. I have no desire to go back to those days.

To suggest that we have hurt more than we have helped through screening for those cancers where the evidence shows otherwise is, in my personal opinion, ludicrous.

I would suggest that cancer screening—as imperfect as it may be—is not the place to start cutting back on your health care. But until that time of perfection comes, please do not provide your readers with scare stories or horror stories that strike fear. Inform, educate, and guide them. But do not scare them. That is a terrible disservice, in my opinion.

Len Lichtenfeld, M.D., M.A.C.P.
Deputy Chief Medical Officer
American Cancer Society

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