Early Detection for Cancer Truths

Early detection fro Cancer
Illustration by Nick Iluzada

For years, it was simple: men over 50 would have regular blood tests to screen for prostate cancer. But last October, the U.S. Preventive Services Task Force scrapped the recommendation after concluding that the screenings did not, after all, save lives.

The change was just the latest in a series of cancer-prevention reversals. We have seen enthusiasm wane for routine mammography while experts still can’t quite agree on how best to screen smokers for lung cancer. Why has all of this become so confusing?

We have been spoiled. The first screening test, the Pap smear, remains by far the best: it is cheap, relatively painless, and provides actionable information. By contrast, the blood-test screening for prostate cancer was a mess because it cannot distinguish between lethal and harmless cancers. Yet once a man was tagged “positive,” he was treated—even if the cancer posed no real health risk. As a result, countless men received the pain, cost, and angst of screening but none of its benefit. The same confusion has muddied the recommendations for breast- and lung-cancer screenings.

We seem very good at inventing the new hot test but less accomplished in determining its limitations. As a result, we have allowed preliminary evidence and good old American optimism to carry us to a place far beyond medical responsibility.

Perhaps what is lacking is a respect for the calm pace required for true innovation. No one was knocking on Dr. Papanicolaou’s door in 1930s, telling him to decide already. He took his time—and gave us a test for the ages.