Should I Be Tested for Cancer?: Maybe Not and Here's Why

This is a very well written short book on the excessive use of cancer testing. The book is divided in two parts. The first part explains the problems associated with the inaccuracy of cancer screening and its implications: painful over treatment including surgery. The second part educates one on how to interpret cancer statistics so as not to be vulnerable to the positive media spin. It also educates as to the limit of research findings. The benefits of cancer screening are often statistically unfounded. This part also educates on how to manage your doctor so you don't get over tested. If you combine the most technology and profit driven medical establishment with the most litigious society, you get a Perfect Storm for excessive cancer testing. That is what we got in the U.S. No doctor will ever get sued because he ordered a cancer test. But, he will if his patients get cancer, and he had not actively recommended a test. As a result, doctors don't take any chances and they scear us in taking many cancer screening test. Cancer tests are deemed to be good for us. Supposedly, the earlier you catch cancer the greater the survival rate. Per the author that is nothing but a simple statistical flaw. We are now tested earlier, and our cancers are detected many years earlier. If you test a population of 50 year olds for prostate cancer, you get a higher survival rate at 5 years, then if you test a population of 70 year olds. Thus, the increase in 5 year survival rate means nothing. The author further adds that mortality rates (of cancer or other causes) has really not changed whether you get tested for cancer or not. Thus, PSA tests and mammograms really don't save lives. Also, cancer incidence has risen to supposedly epidemic levels. But, again this is just due to increase testing. The standard path is to first take a really benign test whose result is more often than not inconclusive (radiologists often disagree). This leads to biopsies that often are inconclusive (pathologists often disagree too). But to remove the uncertainty, radical surgeries are often the next step. The intervention escalated from one level to the next in part because of the perceived threat of malpractice suit. The author advances an excellent argument that the healthy would be better off without that much cancer screening. A lot of cancers that are now uncovered such as prostate cancers are benign and would not affect health or lifespan. Many more men die with prostate cancer than from prostate cancer. He calls those benign cancers a "cancer reservoir." The increasing sensitivity of tests uncovers more and more benign growth from our cancer reservoir. And, that really does not do anyone healthy any good. It leads to overly aggressive painful over treatment. At this pace, the entire male American population will have their prostate removed without gaining a day in lifespan, but with a marked increase in incontinence and impotence. This par

Should I be Treated for Concer? Maybe Not and Here's Why, by H. Gilbert Welch It is hard to put into words the importance of the book, Should I be Tested for Cancer? by Gilbert Welch, M.D., Professor of Medicine at Dartmouth Medical School. It is equally as hard to put into words the courage that it must have taken to write this book. The medical establishment does not look kindly on those who stray too far from the constraints of conventional wisdom. Those of us who seek only about the truth as it pertains to healthcare issues are greatly indebted to Dr. Welch for daring to do so. I have been involved with health care issues for over 28 years. This book is a God-sent and is easily the most important book on this subject I've read in the last decade. Quite frankly, I couldn't put it down. It was given to me by one of my patients who, over the years, has known of my "healthy skepticism" towards many aspects of conventional medical practice, especially as it relates to cancer diagnosis and treatment. The book confirms many of the thoughts that I have shared with my "nontraditional" patients over the years. It is never easy to be perceived as going against the grain of conventional wisdom in any discipline, especially one as emotionally charged as cancer. The author has performed an invaluable service to the many concerned people who dare to think for themselves "outside of the box." A simple perusal of some of the chapter headings reveals all you need to know about where the book is headed: "It is unlikely that you will benefit." "You may have a `cancer scare' and face and endless cycle of testing." "You may receive unnecessary treatment." "You may find a cancer you would rather not know about." "Your pathologist may say it's cancer, while others say it's not." "Your doctor may get distracted from other issues that are more important to you." In Dr. Welch unemotional, factual writing style, we learn about such concepts as "false positives," "pseudo disease," the fallacy of "early detection," suspicious and unreliable "cure rates." We are introduced to the rarely recommended but legitimate treatment option of "watchful waiting" which, for many patients and some forms of cancer, may be the best course of action. We are told that how hard doctors look for prostate cancer affects how much they find. Did you know that there is a saying among doctors about prostate cancer: more men die with it than die from it? There are similar nuggets of wisdom about breast cancer, cervical cancer, and lung cancer. And did you know that you could easily become a victim of a deadly form of medical "political correctness"? Here are a few snippets from the book well worth quoting: "Tests can be wrong, people are made to worry unnecessarily, some are treated unnecessarily, and some are even harmed by treatment." "I will argue that a decision to forgo cancer treatment can be a reasonable option." "If the behavior of doctors and the public continues unabated, even

"Should I be Tested For Cancer, Maybe Not and Here's Why." by Dr. H. Gilbert Welch is an eye-opening and empowering book for anyone facing the decision to undergo cancer screening and possibly become caught in the medical testing quagmire. I discovered Dr. Welch's book at a time when I was facing this medical dilemma myself. The book brings to light many problematic issues regarding the usefulness and validity of cancer screening and testing, which I believe most of us as consumers are not aware of. In particular, Dr. Welch makes the point that, for a variety of reasons, cancer screening/testing may not always be as beneficial as we the consumer have been lead to believe. Dr. Welch's book provides a rational perspective to our society's fear of the threat of cancer. He offers the reader a wealth of information that I believe will help others to make a better informed decision when faced with the issue of cancer screening /testing and possible subsequent treatment. I found his book to be very helpful in alleviating my feelings of fear and helplessness when faced with my own cancer scare. After reading this timely book, my wife and I feel we can be in a position to have a partnership in any future decisions we make with our physicians regarding the choice to undergo cancer screening and/or testing and treatment.. Roo Harris Little River, CA

H. Gilbert Welch, MD, MPH, has written an unusually understandable revelation of the folly of testing for cancer in people with no symptoms. He explains how only a few people will benefit from common tests such as PSA, fecal blood, mammograms and others. He is enough of an insider to be able to explain the flaws in clinical trials being used by "authorities" to recommend extensive testing, and the lack of trials in some cases. The unneccessary biopsies, surgeries, radiations, chemotherapies for slow-growing cancers or even non-malignant ones are presented bravely. The uncertainty of testing is exposed where a positive for cancer may be wrong 1/3 of the time. And it is up to the patient to get second opinions. The financial and legal pressures on MDs to test excessively are brought out. There is advice on talking or writing to your MD to indicate your unwillingness to undergo too many tests, and not to hold your MD liable if a cancer was "missed" - that is the big thing. The deaths caused by cancer treatment are aired. This is something very few people, even MDs, know. Even when a treatment can cut the deaths from a particular cancer in half, most current treatments create non-cancer deaths, many of which will be improperly reported. Welch is a special expert on the misleading nature of 5-year survival rates how they can rise because of early detection, yet with no change in the cancer plus cancer treatment mortality rate. There are good explanations of how 5-year survival rates are calculated, how age-adjustments are made, how randomization for trials is done, and other things not even taught in medical school, but reserved for medical researchers. And quite easy to comprehend with clear figures and tables. No errors that I can find; a really excellent book.

For decades, the American Cancer Society and others have relentlessly campaigned for early cancer detection. And the campaign has been successful - the Journal of the American Medical Association recently reported that only 2% of Americans felt that there are too many cancer-screening tests. Despite this enthusiasm, expert panels of physicians and scientists, after careful reviews of the evidence, do not always endorse screening. Facing these conflicts can be distressing, particularly when confronting issues as serious as cancer. This book offers insights that clarify the issues for patients and physicians alike. As the subtitle suggests, Welch is skeptical about screening, and his text challenges the establishment. However, Welch is not a medical outsider. He is a practicing physician, a Professor at the Dartmouth Medical School, the former editor of a medical journal, and a researcher who has helped reshape professional thinking in articles in the New England Journal of Medicine, Journal of the American Medical Association, Annals of Internal Medicine, and other key medical journals. Using the traditional medical literature, Welch raises some very challenging questions for anyone considering cancer screening. Welch's book provides the reader with a new way to think about testing. He tells how cancer tests may identify disease for which there is no effective treatment, or for which the consequences of treatment are worse than the consequences of the disease. Welch explains why it may sometimes be better not to know you have cancer. In fact, many of us have conditions that will never affect us. In one section, he uses data from the pathology literature to demonstrate how fuzzy the definition of early cancer realy is - that different pathologists can examine the same specimens and come to different conclusions about whether cancer is present. Another section offers easy rules that clarify misleading reports of cancer rates. By walking us through the meaning of cancer statistics for individual patients, Welch clarifies what numbers should be important to individual patients.The bottom line is that this book takes on a difficult topic with remarkable clarity. Dr. Welch provides tools that will help patients play a more active role in their own health care decision making. Robert M. Kaplan is Professor and Chair of the Department of Family and Preventive Medicine at the University of California, San Diego School of Medicine.