The Jessa Hospital in Hasselt organizes Saturday together with the huisartsenkring a symposium on the sense and nonsense of screening. “People think you’re screening for a disease can be prevented, but that is nonsense,” says professor Ann Van den Bruel. “By screening, you have not less likely to have cancer to be, on the contrary. That opportunity is going to just increase.’
The Flemish authorities for years heavily on population surveys of cancer to detect. So can you, as a citizen free screening for breast cancer, cervical cancer and colon cancer. ‘Early …
The Flemish authorities for years heavily on population surveys of cancer to detect. So can you, as a citizen free screening for breast cancer, cervical cancer and colon cancer. ‘Early detection increases the chance of healing considerably’, sounds like the positive message on the website of the government. “But that whole story of screening is much more complex than this one message,” says professor Dirk Ramaekers, medical director of the Jessa Hospital in Hasselt and prof. Ann Van den Bruel, professor huisartsengeneeskunde at the KUL and himself a general practitioner in Antwerp. Both take them today participated in the symposium “the Sense and nonsense of prevention and screening” in the Jessa Hospital in Hasselt.
Screening thus not only meaning. What is the biggest nonsense around screening?
Ann Van den Bruel: ‘In the minds of a lot of people state that screening equals prevention, the prevention of a disease. But that is of course nonsense. At screening you go to a person who has no symptoms, actively search for the beginning of a disease. Some of those incipient cancers do not put by and would never come to light without screening. A screening is not, therefore, ensure that you are less likely to have cancer to be, on the contrary. The risk will just increase.’
Dirk Ramaekers: “When screenings are still benefits exposed, yet there is also a lot of disadvantages. That’s what we want during our symposium in the paint.”
Let’s start with the benefits. What is the population of the three cancers provide the best results?
Van den Bruel: ‘Purely quantitative, the baarmoederhalskankerscreening the most impact. The decrease of the mortality by cervical cancer, the screening seventy percent. At borstkankersterfte there is a decrease of 20 per cent, in cancer of the colon is that 10 per cent.’
By screening we are going to be less likely to die, or so it seems. But as simple as that. What are the disadvantages to screening?
Van den Bruel: “One of the major disadvantages when screenings are the false positives results, where someone is positive on cancer test, but no cancer appears to have. That is a short-term disadvantage. Much more problematic are the overdiagnoses. That is to say that the cancer without screening never came to light. So We are going to people radical treatment for a cancer with radiation or chemo while that actually was not necessary. Because they eventually do not meet the cancer death would have been and even would not have noticed that the cancer was there”
Ramaekers: ‘in Addition, you have small, incipient cancers that spontaneously would cease to exist. Without screening, so there was never any question of cancer. We still go, these people treat. And you should not forget that there is no research is that no disadvantage or complication it brings. Worse still: it is rare but so unnecessary treatment can in the worst case even to death lead.’
Van den Bruel: “Screening is therefore not a naive story of benefit not harm. It hurts always. And sometimes, there are also benefits.’
The ups then is not a good thing?
Van den Bruel: ‘The government assumes that screening is a benefit for the population as a whole. But I think it is especially important that the choice for a screening, the individual is central. For the individual can be a screening very different purpose. If you the one who dies during an examination of the colon, which is intended to colon cancer to detect, then you have that terrible fate. While someone else is the beautiful fate can draw where something is found and the person healed can be. So you could say that for a population that screening can be useful, but that the individual is, however, an expensive price to pay.’
May I tell you a personal question, mrs. Van den Bruel. If you are under the age of 50 years have reached, you will be on breast cancer screening?
Van den Bruel: “I’m not doing that.’
Van den Bruel: “I want women certainly not discourage a mammography, but I think you’re good the pros and cons must be weighed. And personally, I find that the benefits do not outweigh the disadvantages.’
If you lay that out?
Van den Bruel ‘The overdiagnosis for breast cancer is so high, that I risk not want to take. I will see what is happening to me. And if there are symptoms of breast cancer in me would arise, I hope that I have with the best treatment will come through. That is my choice, but I can perfectly live with that patients me to make another choice.’
If women en masse would stop screening, you will not get significantly more breast cancers in an advanced stage?
Van den Bruel: ‘That’s what you think, but that is not so. For the introduction of the screening, we knew how many cancers there were and how many cancers have already metastasized at the time of diagnosis. Since the start of the screenings is the number of breast cancers by 30 percent. But the number of metastatic cancers at diagnosis has remained the same. We had hoped to by used to detect the heavy, metastatic cancers to reduce, but that has not happened. What has happened is, is that we have many more so-called lame, little aggressive cancers have identified, that we are going to treat. But the real problem is there so basically nothing has changed.’
Do you understand the if people, in spite of the disadvantages, however, plenty for a screening want to go?
Van den Bruel: “I understand, yes. People have a natural terror of dying, and certainly to cancer. My mother died of breast cancer. That I would never experience, I hear women sometimes say. If that woman then for a screening, they are more likely to have a borstkankerpatiënt to be, but less likely to breast cancer to die. That is a choice that you as a patient must make. But scientifically speaking that woman by screening no guarantee to get them longer.’
You put a great responsibility on the patient who must decide whether it is screening or not?
Ramaekers: “You hear patients say again: You are all people who are there for so many years studied. Why can you not for me to decide? We, as physicians, can give an explanation, but the final decision is still in the patient. That is why it is so important that we the patients informed: via general practitioners, but also online.’
Is the ups enough said about the cons?
Ramaekers: “I do notice still that in the communication of screenings, especially the positive side is exposed.’
Van den Bruel: “That’s right, all there is, fortunately, already some improvement in sight. If you see five years ago a letter in the bus got to the screening to take part in, then was there no mention of the disadvantages. Now that I have already mentioned, they are still very concise. Therefore, I think a large responsibility lies with the general practitioners that they have good information about what exactly the pros and cons of screening.”
What are the costs of all the population surveys that the government organizes?
Van den Bruel: ‘That is certainly going to be many millions of dollars per cancer.”
Is that responsible?
Ramaekers: “For cancer of the colon, and cervical cancer is probably justified, but for breast cancer can you ask for.”
If the breast cancer screening so under pressure. Why perform we not just finish?
Van den Bruel: ‘I think that politics is very difficult. People have of the government for thirty years need to be told that their breasts need screening. Remember you have the affichecampagnes in which BV’s were raised to to your breasts to make them look. Now going to say: Sorry, it was maybe not such a good idea, we are going to stop. That is of course very difficult. In addition, there is that screenings are also a lot of money involved and they provide quite a bit of work. Thus, it is not so easy to turn back. All I think that the breast cancer screening in the future will evolve. Now there is only screened on age, but I think we are in the future much more at risk of go for screening.’
Is a screening for lung cancer is useful?
Van den Bruel: In the Netherlands there was the Nelson study, in which Belgium participated. Out of that study is that, thanks to a CT scan of the lungs, lung cancer in a much more favorable stage may be discovered. This is the chance for this disease to death with 26 percent. Though I have my reservations about that high figure.’
Ramaekers: “With a screening of lung cancer in smokers, you come also in a discussion on ethics. Lung cancer is often only treatable in an early stage is found. But at the same time, screening for lung cancer is a very precious story and dies today, one in two smokers as a result of his smoking habit. I think we especially need to work on prevention, and so rookstop.’
Van den Bruel: “It is also proven that a smoker who puts a lot more health then post that you are that person is going to screen for lung cancer by smoking.’
Prostate cancer is the most common cancer in men. Should men en masse screening?
Ramaekers: “Of all the screenings is that for prostate cancer the most discussion. At a certain moment there were more PSA testing (a blood test to detect prostate cancer, ed) carried out by individual doctors, than that there baarmoederhalsuitstrijkjes were done. And that while there are sufficient studies that show that the current PSA test, which is already a bit older, a bad test is to have the fast growing prostate cancers to be distinguished from the very slow-growing cancers. So if we’re not good with that screening of prostate cancer deal, is that anyway to overtreatment lead. And gratuitous someone prostate removal, has heavy consequences. The side effects and complications, such as incontinence and impotence, are not to be underestimated. Therefore, that many general practitioners, but also urologists, now regularly the principle of watchful waiting and applying and waiting to see how the cancer evolves. A good thing.’
Why let so many men today still test on prostate cancer?
Ramaekers: “There are still a lot of doctors who systematically do, because in the past they have always done so. In addition, you should also not forget that a lot of insurance companies at the conclusion of for example a home, are still required to take a PSA test.’
Van den Bruel: “in our practice, we ask men to have a PSA test. I try to have them always as well as possible to inform and refer them to a website. There is, for example, to read that only 4 out of 20 men with a raised PSA eventually prostate cancer. If prostate cancer is discovered, who do not always have to be treated, because prostate cancer usually grows slowly. But of course, it is ultimately the patient who takes the decision whether he is for screening or not.”
Ramaekers: “That last is very important. The message of our symposium is not: don’t get screening. The message is: get well informed before you leave the screening.’