Why don’t clinicians discuss cancer screening harms?

Kenny Lin, MD, The Common Sense Family Doctor
Kenny Lin, MD, The Common Sense Family Doctor

By Dr. Kenny Lin

First Posted at Common Sense Family Doctor on 11/3/2013

Kenny Lin, MD, The Common Sense Family Doctor

Recently, I attended a conference that included an exercise where attendees were asked how many patients they thought it was acceptable to diagnose and treat needlessly (or “overtreat”) in order to prevent one death from cancer. We stood at various points along a wall that represented different thresholds: at one end, 100 persons overtreated for every 1 life saved; at the other, 1 person overtreated for every 1 life saved. Not surprisingly, attendees held a wide range of opinions (I stood somewhere in the middle), but the exercise illustrated the tradeoff inherent in effective screening tests for breast, colorectal, and cervical cancer: for every person who benefits from screening, others will be harmed. This fact has led many physicians to advocate thatshared decision-making be used more widely to integrate patients’ preferences and values with the decision to accept or decline a screening test.

How often do physicians take the time to explain the harms of cancer screening to their patients? A research letter published inJAMA Internal Medicine explored this question in an online survey of 317 U.S. adults between 50 and 69 years of age. 83 percent of participants had attended at least 1 routine cancer screening; 27 percent had undergone 3 or more. However, less than 10 percent of participants had ever been informed by their physicians of the risk that the screening test(s) could lead to overdiagnosis and overtreatment. The few physicians who did attempt to quantify this risk generally provided information that was inconsistent with the medical literature.

If the results of this survey are representative of the practices of U.S. primary care clinicians, then more than 90 percent aren’t telling patients that there are downsides to undergoing routine mammograms, colonoscopies, and Pap smears. Why not? Is it because they aren’t familiar enough with the data to accurately describe these harms? Or is it because they fear that patients who receive information about cancer screening harms will choose to decline these tests?


  1. I wish that I never had a mammogram. I had a cyst skeleton drop over a benign mineral calcification. When I refused to have a biopsy, my husband’s insurance threatened to drop the family’s coverage. If he didn’t have coverage, he didn’t have a job.
    I ended up with RSD that didn’t respond well to anything. I finally began stellate ganglion therapy with the shots in the neck. I couldn’t hardly sleep for more than 3 hours, because of the pain. Most of my fingers on my right hand turned black and they flopped. I can use my right hand now. What was scary, was that the surgeons were till trying to do a mastectomy and chemo on me. The radiologists felt sorry for me, and I had an excellent primary care doctor, and they said-BASTA- ENOUGH ALREADY.
    I was talked into going to have my right boob imaged. When I came out of the mammo room, staff and patients were in the lobby- they said- Look at the stupid woman- she had only side imaged, they actually pointed fingers at me and laughed. I did not cry- I did not run. I will never pay to be humiliated again. That was 25 years ago. My husband left me after the pain clinic-so these people want to ruin 25, marriages and lives, 50 -75—-to possible save 1 person. There isn’t any guarantee that the cancer therapy shall be effective for that one person. believe me, there is much more to worry about than radiation for side-effects- surgeons gone wild is another side effect. .