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.