Door to door screening for cancer ??

Today there is an announcement on a door to door screening for Cancer, diabetes and cardiac illness in 100 districts in India costing 250 crores ( 37.5 million dollars) .  I was astonished. I don’t know about diabetes and cardiac diseases, but door to door screening for CANCER ??

Thats not logical or rational nor is it cost effective. I wrote in my earlier blog that screening for cancer is NOT the answer. Sweden is a classic example. Its a country with small population, social health care and all the people are followed up throughout their life. The infrastructure is excellent.

So when mammography screening for population was introduced, it was believed that breast cancer would be detected early. Once detected early, the treatment can be effective and lives  can be saved. It seems so logical and simple. But…

After two decades, the breast cancer mortality did not come down.The women undergoing screening had many false alarms and procedures. Lots of stress and tension and finally NO DIFFERENCE.

Why did this Happen??

There are many biases in screening. Lead time bias is just one of them. Cancer is so much like the human organism and cell. It has finite cycle and also ages. so whether you detect a 5 mm tumour now or a 1 cm tumour after six months, the outcome does not change.

It does not mean that you keep waiting once the tumour is detected. Soon there will be spread to lymph nodes etc.

But screening raises a lot of questions. When to test ? Whom to test? and how frequently should we test?

Pap smear was one such screening  technique and all women above 40 were advised to undergo PAP smear. But logistics of doing a pap smear, once in life time of a lady, are so enormous. It is just not possible.

The cost and the ability to handle doubtful lesions are so much that population based screening like the one planned as door to door testing, is just NOT cost-effective or feasible.

Instead, as I wrote earlier ( Jan 2014) , seven warning signals  can alert us to seek medical attention or undergo tests.

 

 

 

Advertisements

Fearless Crusaders

 

Last Friday was a great day.

In fact I can name it  as the  ‘Survivors’ Day’.

Nearly 10 patients who are long time survivors of 5-20 years came for review on the same day, by random coincidence. It certainly makes one feel happy to see them leading normal lives without any fear

I was particularly happy when Suhasini, a young lady came in with a broad smile. I was very glad to know that she was operated 6 years ago for Colon cancer.

She asked me, “Doctor, can I start my family now”?

I was thrilled as I know that she was single when she got operated.

I said, “Certainly, I would like to meet   the wonderful young man who accepted and married you”. She said he is on the way. “We were courting before I was diagnosed but he never left my side and continued to be my support. After 5 years he convinced his parents and even my parents that he will be with me forever”. As she was saying this her husband walked in. I am genuinely proud of this young man. There are so many instances where engagements are broken after diagnosis not just in a young person but even in their parents. In a society with so many unfound fears and superstitions, this couple stood like a shining beacon. I assured them that everything is fine and they can have a wonderful family.

I do have many instances of such remarkable couples who not only fought the disease but went on to lead their lives with full vigour.

Hats off to such fearless crusaders.