Accelerate, Coordinate, Evaluate Programme: a new approach to cancer diagnosis

Edmund Fuller; Karen Fitzgerald; Sara Hiom

doi:10.3399/bjgp16X684457

Published eLetters

eLetter submission guidelines

Submit a Response to This Article

Compose eLetter

Title *

Author Information

Contributors

First Name and Middle Initial *

First or given name, e.g. 'Peter'.

Last Name *

Your last, or family, name, e.g. 'MacMoody'.

Email Address *

Your email address, e.g. higgs-boson@gmail.com. PLEASE NOTE: your email address will be published.

Occupation *

Your role and/or occupation, e.g. 'Orthopedic Surgeon'.

Affiliation *

Your organization or institution (if applicable), e.g. 'Royal Free Hospital'.

Statement of Competing Interests

Competing interests? *

Yes

Please describe the competing interests

CAPTCHA

This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.

Vertical Tabs

Jump to comment:

Diagnosing cancer early sounds like common sense: the evidence disagrees.
Oliver D. Starr

Published on: 20 April 2016

Published on: (20 April 2016)
Page navigation anchor for Diagnosing cancer early sounds like common sense: the evidence disagrees.
Diagnosing cancer early sounds like common sense: the evidence disagrees.
Oliver D. Starr, General practitioner
Efforts to improve 'cancer survival' by Cancer Research UK is no doubt well-intentioned, but may not be fully grounded in reason.

It is true that cancer survival rates in the UK are worse than other countries,¹ but that does not necessarily mean that people are dying younger or earlier. After all, the UK has one of the highest life expectancies in the world.^₂

I use the paper by Gigerenzer³ to show medical students how it is fairly easy to improve one's cancer 'survival' rates: simply diagnose someone as early as possible.

Consider two men who develop prostate cancer, unknowingly, at the age of 63. One, in the USA perhaps, finds out a year later, at 64, through a screening programme. He undergoes treatment and dies at 70. He has a 'five year survival' of 100%. The other, perhaps British, finds out his diagnosis when it is 'too late' at 69 years old and dies a year later; his five year survival is 0%. Both men have lived with cancer for the same duration of time, but we can see how the five year survival rates are markedly different. What is important is the annual mortality rate from the cancer, not how long one has lived with it.

Various attempts have been made to diagnose cancer earlier, with intensive screening trials for ovarian cancer⁴, colon cancer⁵ and lung cancer.⁶ But e...
Show More

Efforts to improve 'cancer survival' by Cancer Research UK is no doubt well-intentioned, but may not be fully grounded in reason.

It is true that cancer survival rates in the UK are worse than other countries,¹ but that does not necessarily mean that people are dying younger or earlier. After all, the UK has one of the highest life expectancies in the world.^₂

I use the paper by Gigerenzer³ to show medical students how it is fairly easy to improve one's cancer 'survival' rates: simply diagnose someone as early as possible.

Consider two men who develop prostate cancer, unknowingly, at the age of 63. One, in the USA perhaps, finds out a year later, at 64, through a screening programme. He undergoes treatment and dies at 70. He has a 'five year survival' of 100%. The other, perhaps British, finds out his diagnosis when it is 'too late' at 69 years old and dies a year later; his five year survival is 0%. Both men have lived with cancer for the same duration of time, but we can see how the five year survival rates are markedly different. What is important is the annual mortality rate from the cancer, not how long one has lived with it.

Various attempts have been made to diagnose cancer earlier, with intensive screening trials for ovarian cancer⁴, colon cancer⁵ and lung cancer.⁶ But each produced equivocal results which sometimes sound impressive in terms of relative risk reduction but are in fact tiny absolute reductions. In fact sometimes the screened group have a higher mortality rate⁷ because of the complications of false positives and incidental findings, sometimes with disastrous consequences.⁸

Although it is counterintuitive to say 'wait until you get cancer and then get it treated' that is actually the strategy that is borne out by the best available evidence.

Doctors would do well to be cautious of programmes initiated by organisations that are ostensibly charities, but are in reality commercial enterprises.

References

1. Minicozzi P, Otter R, Primic-Žakelj M and Francisci S. Survival of Cancer Patients in Europe, 1999–2007:The EUROCARE-5 Study. Eur J Cancer 2015; 51(15): 2099-2268.

2. World Health Organization. Global Health Observatory (GHO) data. www.who.int/gho/mortality_burden_disease/life_tables/situation_trends/en (accessed 14 Apr 2016).

3. Gigerenzer G, Gaissmaier W, Kurz-Milcke E, et al. Helping doctors and patients make sense of health statistics. Psych Sci in the Public Interest 2008; 8(2); 53-96.

4. Menun U, Gentry-Maharaj A, Hallett R, et al. Sensitivity and specificity of multimodal and ultrasound screening for ovarian cancer, and stage distribution of detected cancers: results of the prevalence screen of the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). Lancet Oncol 2009; 10(4):327-40.

5. Schoen RE, Pinsky PF, Weissfeld JL, et al. Colorectal-Cancer Incidence and Mortality with Screening Flexible Sigmoidoscopy. N Engl J Med 2012; 366:2345-2357

6. Detterbeck FC, Mazzone PJ, Naidich DP, Bach PB. Screening for Lung Cancer. Diagnosis and Management of Lung Cancer, 3rd ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2013; 143(5 Suppl): e78S–e92S.

7. Buys SS, Partridge E, Black A, et al. Effect of Screening on Ovarian Cancer MortalityThe Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Randomized Controlled Trial. JAMA. 2011;305(22):2295-2303

8. KevinMD.com. How the Ca-125 became a $25000 blood test. www.kevinmd.com/blog/2012/02/ca125-50000-blood-test.html (accessed 21 Apr 2016).

Show Less

Competing Interests: None declared.