Should I Be Tested for Cancer: Maybe Not and Here's Why

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$ U% _% J) ]6 `% ~3 R+ uTitle: Should I Be Tested for Cancer?: Maybe Not and Here's Why
& E# t7 v& W7 {0 uAuthor(s): H. Gilbert Welch
- d- E5 g' Y$ x7 P( D9 FYear: 2004
; E# h5 g# \' QEdition: 1
1 D" B  s' N) i" q- \2 q# Q3 ILanguage: English       
" ?1 I% y: K* P2 g( P0 {2 zPages: 234
Size: 835 kB (855045 bytes)
9 _$ H9 U: s! P8 `Extension: pdf
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* e. K; a' R6 U6 T0 E* hGetting tested to detect cancer early is one of the best ways to stay healthy--or is it? In this lively, carefully researched book, a nationally recognized expert on early cancer detection challenges one of medicine's most widely accepted beliefs: that the best defense against cancer is to always try to catch it early. Read this book and you will think twice about common cancer screening tests such as total body scans, mammograms, and prostate-specific antigen (PSA) tests. Combining patient stories and solid data on common cancers, Dr. H. Gilbert Welch makes the case that testing healthy people for cancer is really a double-edged sword: while these tests may help, they often have surprisingly little effect and are sometimes even harmful. Bringing together a body of little-known medical research in an engaging and accessible style, he discusses in detail the pitfalls of screening tests, showing how they can miss some cancers, how they can lead to invasive, unnecessary treatments, and how they can distract doctors from other important issues. Welch's conclusions are powerful, counterintuitive, and disturbing: the early detection of cancer does not always save lives, it can be hard to know who really has early cancer, and there are some cancers better left undiscovered. Should I Be Tested for Cancer? is the only book to clearly and simply lay out the pros and cons of cancer testing for the general public. It is indispensable reading for the millions of Americans who repeatedly face screening tests and who want to make better-informed decisions about their own health care.

1 w, d/ C7 e8 H6 B- j- d) c! cAbout the Author
% u  p  J: V# x1 R, d9 Z( IH. Gilbert Welch, M.D., M.P.H., is Professor in the Departments of Medicine and Community and Family Medicine at Dartmouth Medical School and Codirector of the VA Outcomes Group in the Department of Veterans Affairs, White River Junction, Vermont.
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- Z: [( A: Z& w$ w$ uTable of contents  
Preliminaries......Page 1
CONTENTS......Page 8
Acknowledgments......Page 10
1. It is unlikely that you will benefit......Page 28
$ O" Y5 Q" b2 h+ X3 W( n; J2. You may have a “cancer scare”......Page 44
% t2 C2 [. c) E# p4 U# Y3. You may receive unnecessary treatment......Page 62
4. You may find a cancer you would rather knew about......Page 77
2 p2 l% e% R7 Z3 {: Y5. Your pathologist may say it’s cancer, while others say its not......Page 101
6. Your doctor may get distracted from other issues that are more important to you......Page 117
5 {7 s9 K- \$ o  F5 E# _7. Understand the culture of medicine......Page 126
8. Understand the statistics of cancer......Page 140
9. Understand the limits to research......Page 163
10. Develop a strategy that works for you......Page 188
( z) Q0 Y* r  t3 n( iAppendix......Page 202
8 }7 K) g' ^% {Glossary......Page 204
Notes......Page 210
Index......Page 230

Editorial Reviews
; r0 e2 X1 ~3 h/ l6 y% i9 p. ]2 |From The New England Journal of Medicine
; H4 f( g: v' x2 G6 XIn the absence of well-reasoned skepticism, medical practice can become enraptured with the potential of new technological advances. In this insightful how-to book on health care, Welch provides a comprehensive overview of current challenges in cancer screening. He draws from published literature, case histories, and his own medical practice in discussing the risks and benefits of screening, thereby exposing the true limits of current technology and of our knowledge as to how and when to intervene against early neoplasia. This comprehensive book has two parts, "Problems You Should Know About" and "Becoming a Better-Educated Consumer." Part I lays out the premise for early detection and gauges the risks and benefits that most people might derive from screening, given their susceptibility to cancer and the competing causes of illness and death. Part II details the practice of early detection and instances in which nonmedical factors -- such as human vulnerability, social forces, and fear of litigation -- have sometimes led to overzealous adoption of unevenly effective techniques for cancer screening. A comprehensive index accompanies the text, along with useful commentary that expands on and qualifies selected excerpts. Welch's lucid presentation of complex and timely issues is an achievement in itself, but even more, this is an eminently readable book that is bound to inform and complement the ongoing debate about screening. The author maintains that cancer screening may have been oversold to the public and health care practitioners alike. By challenging commonly held assumptions, Welch stimulates a critical dialogue between patients and providers regarding the effect of screening on cancer-associated morbidity and mortality, the sequelae of false positive results, and the slippery slope of diagnosing and managing incidentally detected cancers, many of which may pose no immediate health threat. To balance this cautious approach to cancer screening, the author acknowledges the successes of rigorously proven screening methods and weighs them against the high costs that invasive cancer imposes. Indeed, leading health economists recently estimated that as little as a 10 percent reduction in cancer would translate into a savings of $4.4 trillion to society. This book, which offers a sobering view of the status of cancer screening today, deserves to be widely used by patients and providers as they navigate an expanding and often bewildering array of screening options. Nevertheless, improvements in our understanding of carcinogenesis, enhanced performance characteristics of early-detection technology, and noninvasive approaches to diagnosing early neoplasia are likely to narrow the gap between the detection of disease and its appropriate medical management. These advances are likely to recalibrate the risk-benefit ratio of cancer screening. Indeed, transient uncertainties and potential harm should serve as an impetus for scientific advancement, rather than as evidence of conceptual failure. In an evolutionary sense, the dilemmas so well detailed in this book may be viewed as natural preconditions for continued progress. Jaye L. Viner, M.D., M.P.H.
Copyright © 2005 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS. --This text refers to an out of print or unavailable edition of this title.
1 ~% V0 j6 g0 J8 L. NFrom Booklist
1 j1 D# k6 O; f9 K! M' iThe cost of medical malpractice soars as patient lawsuits proliferate, and healthcare providers react with rounds of "defensive testing" that boost insurance costs. Add to those trends "early detection" as the watch(buzz)word associated with the most dreaded of diseases, cancer, and you have Americans possessing health coverage routinely undergoing test after test. What of the downside of testing healthy people? Welch, a specialist in cancer detection, challenges common knowledge about everyday screenings, such as mammograms and PSA (prostate specific antigen) tests, citing patient anecdotes and research data on the most commonly diagnosed cancers in this readable, thought-provoking book. He argues that of the two basic cancer-prevention strategies--health promotion (diet, exercise, etc.) and early detection--the latter is the easier sell, and he notes that most tested people never develop cancer; screenings tend to miss the fastest-growing, most deadly cancers; and cancer-free patients with abnormal screenings often endure seemingly endless, sometimes risky testing that leads to unnecessary treatment. Accessibly written, Welch's perspective provides needed balance to current emphasis on testing. Whitney Scott
* }. y. Y! G0 ~Copyright © American Library Association. All rights reserved --This text refers to an out of print or unavailable edition of this title.
Review
“One of those gems to come out of the academic press. . . . If you’re worried about cancer, this lucidly argued book will be a godsend.”
+ f2 w5 X: J- O(Malcolm Gladwell The Week 2009-01-16)
From the Inside Flap
$ l! q# P7 T* e* E  y"I have long been a fan of Dr. Welch's research and his considerable insight into the dilemma of disease screening. I'm profoundly grateful that he has now made this information available to everyone in an easy-to-read, practical book. Should I Be Tested for Cancer? is a must-read for every doctor and patient in this country."—Christiane Northrup, M.D., author of Women's Bodies, Women's Wisdom

"I did not think it possible to bring such a dry topic to life, but Dr. Welch has done it. He writes wonderfully well. For anyone interested in cancer screening or preventive medicine, this book is a page-turner. It will be a rare person—layperson or health professional—whose perspective is not changed by reading this provocative book."—Alfred Berg, M.D., M.P.H., Chair of the U.S. Preventive Services Task Force
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"Dr. Welch has performed an invaluable public service. Whatever the successes of the nation's 'war on cancer,' too many people now believe it's always in their best interest to detect the disease early and rout it, regardless of the costs. This book will inject reason and good sense into an arena of medical decision making often dominated by hype and fear."—Susan Dentzer, Health Correspondent, The NewsHour with Jim Lehrer

From the Back Cover
6 O' Q0 Y8 j8 t2 \"I have long been a fan of Dr. Welch's research and his considerable insight into the dilemma of disease screening. I'm profoundly grateful that he has now made this information available to everyone in an easy-to-read, practical book. Should I Be Tested for Cancer? is a must-read for every doctor and patient in this country."-Christiane Northrup, M.D., author of Women's Bodies, Women's Wisdom "I did not think it possible to bring such a dry topic to life, but Dr. Welch has done it. He writes wonderfully well. For anyone interested in cancer screening or preventive medicine, this book is a page-turner. It will be a rare person-layperson or health professional-whose perspective is not changed by reading this provocative book." Alfred Berg, M.D., M.P.H., Chair of the U.S. Preventive Services Task Force "Dr. Welch has performed an invaluable public service. Whatever the successes of the nation's 'war on cancer,' too many people now believe it's always in their best interest to detect the disease early and rout it, regardless of the costs. This book will inject reason and good sense into an arena of medical decision making often dominated by hype and fear."-Susan Dentzer, Health Correspondent, The NewsHour with Jim Lehrer --This text refers to an out of print or unavailable edition of this title.

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