According to Norwegian research, screening for cancer is of little use: people no longer live because of it. Nevertheless, considerable effort is being put into this type of population surveys. What should you believe? This is why the Netherlands continues and believes in it.
In the Netherlands you can have yourself screened for breast, uterine and colon cancer. Particular attention is paid to groups that are most at risk. For example, women between the ages of 50 and 75 can have their breasts checked every 2 to 3 years, and women over 30 can have a Pap smear every 5 years. The Ministry of Health is also looking into extending the program to lung and prostate cancer.
A longer life?
Yet this preventive screening of people for cancer has hardly any effect, researchers write this week in the scientific journal JAMA. University of Oslo professor of medicine Michael Bretthauer led the research.
“You often hear the slogan that cancer screenings save lives. We wanted to know if that’s true,” he says. “Our research is not about whether these types of screenings work in general, i.e. whether cancer is detected, but whether they make you live longer. That is not the case, and it is often promoted that way.”
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Some live shorter
Two groups were compared in the study: people who underwent cancer screening and those who did not. In the end, the first group lived on average no longer than the second. There was only a slight gain in colorectal cancer research, of about 3.5 months.
But how is that possible? Bretthauer explains: “It doesn’t mean that everyone dies at the same time. Some people are diagnosed with cancer in time, they get good treatment and live longer as a result. But on average, the group ends up not living longer. That means that some people also shorter life after a screening.”
Which group do you belong to?
According to the researcher, this is also known to happen: cancer treatments come with risks. “People can die from complications from surgery. Radiation and chemotherapy are heavy treatments that can be dangerous. Usually nothing happens, but we see that about 1 to 2 percent die from the treatment.”
“So that cancels out the effect of people living longer. And the problem is, if you get screened, you never know which group you will belong to. Is that the group that lives longer, or shorter?”
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Minister Kuipers: screenings will continue
After the publication of the Norwegian study, the Dutch Ministry of Health quickly announced that population screenings will continue ‘as usual’. Minister of Health Ernst Kuipers explains this further: “What the researcher claims is that if you are diagnosed with cancer, you will be treated early and live longer, which has no effect on the population as a whole.”
And that is also the case, the minister acknowledges. “If you improve the survival rate for one individual, what does that mean for all the other people who don’t have cancer? It shouldn’t surprise you that the effect is very small.”
‘Make your own consideration’
However, he believes that the interest per individual is the most important. “As an individual you will say, ‘I’m glad this was found with me.’ And what that does to the life expectancy of people in your village is completely irrelevant.”
According to Kuipers, the new research into cancer screenings can ’cause confusion’. “I want to tell people: if you get an invitation, make your own consideration. You make that for yourself, your partner and for your environment.”
audio-play
Hila Noorzai tells more about the new research into cancer screenings in the studio
Mortality from specific cancer
As professor of Personalized Cancer Screening at Radboud university medical center in Nijmegen, Mireille Broeders is closely involved in population screening for cancer. Just like for the minister, the usefulness of the screenings is not in question for her.
“This research sometimes makes choices that I would not have made,” she responds. “You have to look at the mortality from the specific cancer you are screening for and whether that is being reduced. And if cancer is discovered during a screening, can you also offer a less intensive treatment, for example?”
Advantages and disadvantages of population screening
“There are different advantages and different disadvantages of population screening,” says Broeders. “I think it’s a shame to pick just one and say, ‘I don’t see an effect there, so cancer screenings are useless.'”
“We are looking for people who do not yet have any complaints, but who still have cancer. Fortunately, there are not very many of them, so that has little effect on the large group,” she continues. “But it’s about the difference you can make within that group. If you’re that one person who’s diagnosed with cancer, I think you’ll be very glad you went to the study.”
‘Look beyond these numbers’
“I would hope that people would not have doubts about participation on the basis of this study,” Broeders urges people. “There is a lot of information about these studies known in the Netherlands. I hope they look beyond these figures about total mortality.”
“If you participate and turn out to have cancer, you really benefit from that screening.” Still, like the Norwegian researchers, she emphasizes that there can be disadvantages. “Many people do not have that cancer and of course they also have a chance of disadvantages. You have to take that into account.”
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Researcher: ‘Screenings don’t have to stop’
Despite his results on longer life, researcher Michael Bretthauer also does not think that cancer screenings should stop completely. “I’m not saying that. There may be more benefits than just living longer. If screening detects cancer earlier, you may have a better quality of life in the time you have, for example.”
“But you can’t expect to live longer because of it. You will probably die from something else at about the same time.”
Attention to the risks
“So the slogan ‘cancer screening saves lives’ is misleading. Because some people live shorter because of it. So I don’t think you should say that.” According to Bretthauer, better other benefits can be promoted, such as that better quality of life.
“But the risks must also be clear. Provide clear figures about the possible negative consequences of a treatment.” Now, according to him, that does not happen, or too little. “Only when people have all the information can they make an informed choice for themselves whether they want to be screened or not.”
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2023-09-01 12:47:28
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