Readers React: Why you should be skeptical of calls for reduced cancer screening

To the editor: Dr. H. Gilbert Welch misses the point regarding the appropriate use of screening tests. The large-scale problem in this country is not overscreening but rather underuse of testing proven to detect lethal diseases at potentially treatable stages. (“We should look less hard for cancer,” Op-Ed, Nov. 19)

Most every death from colon and cervical cancer could have been prevented with appropriate use of colonoscopies and cervical screening. Advances in detecting prostate cancer, one of the more challenging and heterogeneous cancers, are making it easier to determine which cancers merit watchful waiting versus aggressive intervention.

A great challenge that Welch does not mention is that every “new” guideline — especially those written with no new data to support their recommendations and those by “experts” who are not specialists in the specific disease — often confuse patients and practitioners alike.

In the end, skepticism often leads to discounting of the value of screening at all, leading to worsened patients outcomes because of changing policy.

Benjamin Ansell, MD, Los Angeles

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To the editor: Welch cites the PSA screening test for prostate cancer and mammograms for breast cancer as examples of overdiagnosis.

We don’t need less testing; rather, we need to be wary of how doctors interpret and use test results, and most critically that they do not use test results to do more procedures that are not warranted.

Jim Gould, Burbank

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To the editor: This article brings up a most distressing reality: How early a patient is diagnosed with colon cancer depends on the type of health insurance he or she has. (“Medi-Cal cancer patients don’t fare much better than the uninsured, UC Davis study says,” Nov. 19)

Medi-Cal patients have the lowest rate of diagnosis of colon cancer in an early stage, when the disease is most curable: Only 20% of them had the cancer diagnosed in Stage 0 or I and 23% in Stage II. The

UC Davis study considered the financial realities of various major health insurance programs.

My 35 years of service as chairman of the cancer program at the Long Beach VA medical center showed that in addition to the finances of healthcare, a commitment to making an early diagnosis results in the best performance. Indeed, the article notes that among VA patients with colon cancer, 48% were diagnosed in Stage 0 or Stage I, and 20% were diagnosed in Stage II.

This is the key to a cancer cure.

Edgar M. Moran, MD, Long Beach

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