13 November 2010

Another shock-horror cancer story

What is the National Cancer Intelligence Network? Dr Grumble has no idea. Perhaps they are one of those quangos that have bitten the dust. Perhaps cancer is seen as so politically important they have been saved. Probably our taxes pay for it.

Anyway, according to the shock-horror story on the BBC web site this organisation has discovered that one in four cancers are detected at the emergency stage. In acute leukaemia half of cases were only discovered at a critical stage. And the same was true of brain cancer.

So yet another story telling us about how bad we are in the UK at diagnosing cancer. But it doesn't really bear much scrutiny. Acute leukaemia by definition comes on acutely. It has a rapid, short and severe course. You cannot diagnose it early because before you have it it is not there. As for 'brain cancer', contrary to popular belief, very few headaches turn out to be a symptom of tumour. Headaches are so common that people with headaches and no other signs or symptoms are said to be statistically no more likely to have 'brain cancer' than people without headaches (Mitchell et al 1993). It follows that 'brain cancer' will inevitably tend to present when the patient has a seizure or develops more worrying symptoms or signs.

The next question to ask in all of this is whether it actually matters if there is a delayed diagnosis. There is only any point in diagnosing 'brain cancer' early if earlier treatment would help. The same goes for conditions that we could more easily diagnose early such as prostate cancer. Of course, as is clear from the US versus UK survival figures, your survival will be longer if you are diagnosed early with prostate cancer. Just as the journey from Birmingham to Edinburgh is longer if you board the train in Exeter. But you might, at a cost, be able to cure it too. With earlier detection come the questions. These are the issues we need to be addressing.


hyperCRYPTICal said...

The media throws this and that medical information at patients, almost on a daily basis; however, it cannot provide the public with a sound medical knowledge base to fully understand the information given.

It is in this context that shock-horror stories evolve into 'mass panics', where Joe and Jane Bloggs begin to doubt innocent smyptoms, believing that they could be an indication of something more sinister.

It is unfortunate that some in the medical profession are keen to jump on this media bandwagon (ego trips?), and lay (I have not long read your second comment on JD) the sins of the world at the doorstep of GPs.

GPs, as all doctors, are only human and will occasionally make bad clinical judgements; but I doubt that even the most excellent doctor is so skilled in that (s)he can diagnose a symptomless condition.

Mass screening often highlights innocent lumps and bumps, leading to unneccesary interventions and the anxiety that they bring.

Going off on a tangent - what happened to the common cold? Is it nearly eradicated? I ask this as I seem to be one of the few people who catch it - everyone else I know, catches flu!

Anna :o]

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