Wednesday, March 7, 2012


This is a follow up to yesterday's post which I believe is a bit difficult to read.  It was in medical speak and frankly, I did not have the brain power to offer a simple explanation.  This should not be ignored by anyone.

Enter, Reuters Health.  THIS is the plain English explanation I needed!  And, despite my open disdain of soundbites and quotes pulled out of context, a bigger gripe is the way statistics are used to push and agenda and my biggest gripe is listening to ANYONE and particularly SOMEONE blab on and ON about those Five Year Survival Rates.

Maybe I'm just one of those overly sensitive people.  Is it the word survival?  Is it the magic bullet bill of goods we have been sold about hitting the five year mark?  Clueless.  What I DO know?  It's a bit disconcerting to read the CliffsNote version of yesterday's news which in which Reuters claims "most doctors (are) baffled by cancer screening stats."

I'm beginning to feel like a school teacher or a kid who just learned how to use bulleted points but there are a few GREAT points made.  Remember this is all regarding screening for cancer.  Because we all KNOW early detection SAVES ALL LIVES.  At least that's what some would lead most to believe.

Here goes and these are the ones I found most disturbing (&/or irritating and you will know when you hit "irritated".... just trust me.... it will require no special font.... yes, you will just know):

  • The chief medical officer of the American Cancer Society saying this is really "unfortunate" because we always say "discuss it with your doctor" and now there is "evidence that your doctor doesn't know." (How positively comforting.  Way to **word drop** impart confidence)
  • Misunderstanding of statistics has been fueling more screening.  (Who is pushing an agenda-I'm really trying to stay out of the conspiracy theory pond, discuss among yourselves)
  • Despite what the doctors have been taught, this "overdiagnosis" which is catching cancer early is being called into question.  (Can we all say tort reform)
  • DEATH rates gleaned from clinical trials is the ONLY reliable way to determine if screening is effective.  (Death, or not, IS the only real indicator when you come right down to it)
  • Organizations that promote screening such as Komen tend to prefer survival rates which sound more impressive although survival rates are misleading.  (no comment)
  • "There are a lot of actors here who could do a better job." (not sure what that meant but it was RIGHT after the Komen shout out--discuss amongst yourselves)
  • Better guidelines for how to report studies would be beneficial.  (Ummm, duh, Ya Think?)
  • The solution might be the standardization in the naming and reporting of statistics in a way that makes sense not only for doctors but also for journalists and the lay public.  (This guy, Dr. Elie Akl deserves The Big Prize-The Really REALLY Big Prize.... A-Freakin-MEN! AND, I might direct you back to yesterday's post where I DID make a similar observation... just sayin')
  • If a patient asks a doctor about risk v reward of a particular screening and the doctor answers there is an increase in five year survival, the patient should run the other way, because apparently, "their doctor doesn't know what they are talking about." (What a positively comforting thought, the same positively comforting thought in the first point.  In other words, we've just gone in one big circle)
  • The EMPOWERED, EDUCATED patient may be asking the right questions, but they ain't necessarily getting the right answers.  (Speechless, yes, ME, speechless)

Those are a few of my favorites and in case the link is broken, for posterity and in its entirety without any edits, I give you Reuters Health written by Frederlk Joelving.

Most U.S. doctors baffled by cancer screening stats

NEW YORK | Mon Mar 5, 2012 5:15pm EST
(Reuters Health) - Most U.S. doctors fail to grasp simple statistics about cancer screening, which could boost their enthusiasm for unproven and potentially harmful tests, a new poll suggests.
For instance, three-quarters of the more than 400 doctors surveyed believed better survival rates prove screening is a lifesaver although that's not the case, researchers say.
And nearly half thought early detection translates into saving lives -- another common misperception.
"This is really unfortunate because one of the things we always say is, 'Discuss it with your doctor,'" said Dr. Otis Brawley, chief medical officer of the American Cancer Society. "This is evidence that your doctor doesn't know."
Brawley, who wasn't involved in the new survey, said the lack of statistical sophistication among doctors is part of the reason why prostate cancer screening, now a controversial practice, has become so widespread.
"Misunderstanding of statistics has been fueling a great deal of screening," he told Reuters Health. "Unfortunately we have all been taught that the way to deal with cancer is to find it early. As we have learned more and more about cancer, we are starting to find that that's not true."
The reason is that screening automatically increases survival rates, because finding a tumor early means people live longer with their cancer diagnosis than if they had waited until they had symptoms to see a doctor -- regardless of whether or not anything is done to treat them.
In some cases, such as slow-growing prostate cancers, the tumor might never have bothered them in the first place. That means screening, and the further tests and treatments that might follow, would have led to costs and potential side effects without any benefit to the patient -- a phenomenon called overdiagnosis.
"For helping people understand if screening works, survival rates are misleading," said Dr. Steven Woloshin, of Dartmouth Medical School in Hanover, New Hampshire, who worked on the new survey.
He told Reuters Health that death rates gleaned from clinical trials are the only reliable way to judge if a screening test is effective. But organizations that promote screening, such as the breast cancer charity Susan G. Komen for the Cure, tend to prefer survival rates, which sound more impressive.
"There are a lot of actors here that could do a better job," Woloshin said.
The new findings are based on responses from 412 U.S. primary care physicians surveyed in 2010 and 2011, and were published Monday in the Annals of Internal Medicine.
When asked if a better survival rate proves that screening saves live, less than a quarter of doctors answered correctly that it doesn't, while 76 percent believed it did.
Forty-seven percent of doctors also mistakenly thought early detection of cancers is proof that screening saves lives, while 49 percent correctly answered that that's not the case.
"It shows that there is a lot of confusion out there," said Woloshin. "It is sort of understandable, because I don't think doctors necessarily get a lot of education about statistics."
When Woloshin's team quizzed doctors about two hypothetical screening scenarios, the responses were just as discouraging.
Doctors were three times more likely to recommend a test that increased the (irrelevant) five-year survival rates from 68 percent to 99 percent than to recommend a test that slashed the much more important death rate from 2 in 1,000 people to 1.6 in 1,000.
"Physicians clearly do not understand how to interpret cancer screening statistics themselves -- expecting them to communicate this information to patients is a stretch," Dr. Virginia A. Moyer, who chairs the government-backed U.S. Preventive Services Task Force, said in an editorial on the new poll.
Dr. Elie A. Akl of the University at Buffalo in New York, who has studied risk communication, said better guidelines for how to report medical studies are important.
"The solution might not (just) be further education of physicians but also standardized naming and reporting of statistics in a way that makes intuitive sense, not just for clinicians, but also for journalists and the lay public," he told Reuters Health by email.
In the meantime, patient advocacy groups can help educate consumers about the questions they should be asking their doctors, said Brawley, the author of How We Do Harm: A Doctor Breaks Ranks About Being Sick in America.
"What are the harms of this screening test? What are the potential benefits? If the patient gets an answer of increased five-year survival, that's an indication that their doctor doesn't know what they are talking about," Brawley said.
SOURCE: Annals of Internal Medicine, March 5, 2012.


  1. The magic five-year survival rate. When you first come out of treatment, you may count down the years until you reach this day. It takes on an almost mythical status - if you get to five years you are “cured”. I remember when I reached my own five-year milestone mentioning it to my oncologist at my check up and he swiftly replied there is no such thing as a magic “five-year cure". I remember being upset at the time - but reading your post today I have to revise my opinion and think he was more enlightened than I gave him credit for at the time!

    1. I know that the statistical odds go down as we distance ourselves from our original diagnosis. But that's the odds of a recurrence. No one talks about the fact that we just jumped up in the "risk factor" category for developing a second primary cancer. People seem to forget there is a difference. THIS is why I tend to dislike (despise) statistics. And besides.... STATISTICALLY, I pulled the short straw EVERY time I was told something during the time they were attempting to figure out what was happening to me. I fell on the 10% whose "suspicious area" was cancer. The other nine people that day..... they all got good news. And that's just life. Take what's been handed to you and do what ya gotta do....

      Thanks, Marie....


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