Cancer Screenings: What Should Nurses Say?

I know that, because I’m a nurse, I’m going to be asked by more than one person what I think of the American Cancer Society’s new stand on the benefits and problems of screening for some cancers.

According to a story by the New York Times, the society is “quietly” preparing a statement that will say that the benefits of screening for prostate and breast cancers may have been overrated. I suppose the “quietly” part is an effort not to cause a major public uproar or freak-out. After all, we Americans have had it drilled into our heads the importance of screening for breast and prostate cancers and catching these diseases early. We consider screening a right.

However, the statistics on cancer outcomes make the experts not-so-sure anymore about the wisdom of screening.

According to an analysis recently published in The Journal of the American Medical Association, there has there been a 40 percent increase in the diagnosis of breast cancer, but only a 10 percent decrease in the breast cancers that metastasize. A large increase in early cancers should be balanced by an equal decrease in late-stage cancers, which is what has occurred with screening for colon and cervical cancers.

“The issue here is, as we look at cancer medicine over the last 35 or 40 years, we have always worked to treat cancer or to find cancer early,” Dr. Otis Brawley, chief medical officer of the cancer society, told the Times. “We never sat back and actually thought, ‘Are we treating the cancers that need to be treated?’ ”

The hard and scary reality is that medical science still doesn’t know which types of cancer have the ability to invade aggressively and which types could or should be left alone. Treating slow-growing cancers can cause more harm than good, but when we hear the word “cancer,” we want to shout, “Take it out!”

We know that many men who have been diagnosed with prostate cancer choose the “watchful waiting” option, and rightly so. They often die of some other cause before the prostate cancer becomes a problem. In addition, the PSA test is far from the exact science we once thought it to be.

When it comes to breast cancer, though, I’ve never heard of a “watch and wait” option. Imagine the outrage at any physician who advised a woman to “watch the lump” for awhile. It’s fair to say that many women consider getting yearly mammograms as routine and important as preventive visits to the dentist or taking a daily vitamin.

I often have to remind myself and others that there is still a lot we don’t know about the body, cancer and treating disease. There are so many stories every week about new discoveries, research and promising drugs and other treatments that it’s easy to get caught up in the hype and jump to conclusions. But as nurses, we need to remind patients and anyone who asks that there are no magic bullets or one-size-fits all when it comes to conquering disease.

What will I say when asked about continuing with screenings for prostate cancer and breast cancer?

I’ll encourage women to continue to get those mammograms, and for men, the digital exams and PSA (with the caveat that the numbers can be deceiving) until somebody really proves that the harm done really outweighs the good.

What do you think?