麻豆传媒

Should I Be Tested for Cancer? by H. Gilbert Welch, University of California Press, $19.95/拢12.95, ISBN 0520239768

THE medical screening industry in the US is now completely dysfunctional and totally out of control. And where the US leads the rest of the world is sure to follow. So I warmly welcome Gilbert Welch鈥檚 intelligent and eminently readable Should I Be Tested for Cancer? as a timely reminder that screening is not all it鈥檚 cracked up to be.

Welch points out that the common-sense mantra 鈥渃atch it early and we will save your life鈥� is a gross oversimplification that exploits a naive public. They thus find themselves trapped in a pernicious triangulation between a cancer phobia that feeds unrealistic expectations, defensive medicine caused by the medical profession鈥檚 fear of litigation, and a profit motive in the US or political expediency in the rest of the world.

Welch shows the biases of screening such as lead-time, which inflates survival statistics; 鈥渓ength bias鈥�, which results in screening catching the good cancers while the bad cancers slip through the net; and the over-diagnosis of latent disease, which he describes as 鈥減seudo-cancers鈥�, that artificially increase the 鈥渃ure rate鈥�, while exposing large numbers of people to over-treatment. Most frightening of all, Welch describes a scenario of more screening for more diseases, doctors becoming more defensive, and pathologists more vigilant, until we end up with the entire population diagnosed with cancer.

This is a book that should be read by all healthcare providers and all symptom-free individuals who are being coerced into a screening test. Sadly, in my experience the zealots who need to be re-educated will hate having their complacency disturbed.

Or, as Ogden Nash put it: 鈥淚 cannot help mentioning that the door of a bigoted mind opens outwards so that the only result of the pressure of facts upon it is to close it more snugly鈥�.