Murky Water

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Creak. A man sits down in the green chair, anticipating the test results come back fine, waiting for the doctor to come into the room. The doctor comes in, sits down and he’s in total negativity before the doctor even opens his mouth. “Your test results came back positive, but we caught it so early, we need you to tell us if you want us to proceed with further tests.” What would you do? Every year the human race puts themselves through tests that poke, prod, and cause them pain just to make sure they are healthy, but what if not all of that is needed? Medical tests are expensive, not all the doctors are educated enough to deal with the results, and patients are having to choose how to deal with early detection results; sometimes advancements in technology do not have great side effects.
We, as a society, place everything we have on education, but have we ever thought about what happens when education fails us? When we become sick or hurt and don’t know what is wrong, our first reaction: go to the doctor. Even when the doctor doesn’t know what is wrong, we’re left, still searching for answers. The threat of not knowing what is around the corner can drive many citizens crazy. For example mammograms detect cancers so small that many doctors do not have the education needed to treat the patient, so some of the potential hazardous cancers may turn out to be nothing at all. As Doctor Robert Smith, director of screening for the American Cancer Society puts it, “Modern medicine doesn’t have the sophistication needed to pick out a deadly cancer from a harmless one.” And doctors are starting to learn of mistakes they have made with patients.
A great example of this happened in the mid 1980s, when Japan began a screening test for neuroblastoma that lasted twenty years. Neuroblastoma is a tiny tumor within the brain and the results from the study were mind blowing. The main individuals that were tested included babies and young children. One million, 80 percent of infants in the country, were tested. Neuroblastoma affected children as young as six months to children as old as six years, and every child that was diagnosed had surgery, radiation, or chemotherapy. The trouble was that there were two types of neuroblastoma: one that was harmful and one that went away on its own. But the screening only identified one kind, the benign one. The treatment exerted on these children may have killed, deformed, or harmed them. The doctors were trying to lower the death rate, but the test did nothing to the death rate of children with the harmful neuroblastoma; rather it harmed one million babies who were not sick at all.
Even after the screenings in Japan, citizens are still being hurt in the United States. A biopsy is “a reasonable approach because we don’t have a perfect approach for those patients,” says Doctor Anthony Smith urologist from the University of New Mexico. If a man was diagnosed at 63 with prostate cancer, died at 66, he was a three year survivor. But if you tell a man who was diagnosed at 60 who died at 66, he was a six year survivor which sounds much better, although both men died at 66. Which means that even though the public hears six year survivor, the citizens did not live any longer than the other man. Likewise the next time someone goes to have a screen make sure the doctor knows the answers to these questions: what is the likelihood of dying of that particular cancer in a year? In ten years? In a lifetime? And out of 1,000 individuals with the same background, how many would die? If he/she can not answer these questions go somewhere else.
A new treatment is, STPB, (stereotactic transperineal prostate biopsy), created by Doctor Moran, consists of inserting a needle in the space between the rectum and the scrotum. This has lead to the development of new drugs that can control tumors, turning cancer into a condition like diabetes. With these early tool, doctors can treat the deadly cancer more accurately. When the apparent cancer, is found the patient can choose from surgery, chemotherapy, radiation, or “watchful waiting”. H. Gilbert Welch, author of Should I Be Tested For Cancer? says, “The idea that a good screening test is the one that finds the most cancers is totally wrong.” Which means that even with this new test, the results might not come back with the right answer.
The shock and pain from cancer tests is not the only element felt by the general public, but the expense is on the mind of many. Mr. MacMahon went to his doctor for a regular prostate checkup when one out of twelve cells came back positive for cancer. He had a choice to either have more extensive tests or have his prostate removed. In the end Mr. MacMahon spent $10,000 out of pocket that year on tests, consultation cost, nutritional supplements, and $ 2,000 on DNA to prove it was his, Mr. MacMahon, and not someone else’s. As Doctor Scardino said, “The area we were worried about was probably not cancer, but a shadow.” Now if that doesn’t make us a little worried about the kind of treatment the patient is receiving.
Doctors are recommending too many unnecessary tests which cause many people, who don’t or have very little insurance, to go bankrupt. But of course with everything, taxes and funding, the government has a say in what goes and what doesn’t. Many insurance companies will not cover tests not recommended by the government or cancer societies. This means that if a mammogram or colonoscopy misses cancer and there is newly developed tests don’t think about having it just yet because unless you want to pay out of pocket for it, you might not get it. There are two types of medical insurance: standard and comprehensive. Standard covers in patient and day care only at a hospital or emergency room. Comprehensive covers outpatient treatment, dental care, complementary medicine, maternity travel, and personal accident care. But both kinds exclude any chronic or critical illness that cannot be cured, such as multiple sclerosis, asthma, and diabetes. It also does not cover hazardous sports, treatment overseas, and a normal pregnancy. It is amazing that, even with the economy hitting rock bottom, medical insurance companies continue to raise payments the older you get.
So in the end Mr. MacMahon concluded “They’re basically saying that they might take out my prostate and find nothing.” To the ASC (American Cancer Society) women, it is fine to spend money freely, because they spent over 10 million dollars to promote women over forty to have yearly mammograms. These mammograms are not the best for the pocket or the medical resources they use. The ASC women should take the money they used to promote mammograms and use it to instead find ways to detect harmful cancers earlier. Another group, the NCI (National Cancer Institute), spent over twenty million dollars to promote mammograms to older women and women over forty. As a whole, the money spent in promotions should be shifted because in the end one cell can lead to many tests, when half the time the doctor does not know if it is benign, cancerous or perhaps nothing at all. Because with the rapid advancements in medical technology, the doctors are not skilled in using the new devices.
It is said that women can be very trusting and when something is drilled in their minds, it takes a lot to shake them up. Everything they know could be wiped out in a single minute with one doctor’s visit. When it comes to cancer tests there is only one test that has proved to save lives, and that is the Pap smear. It has reduced deaths from cervical cancer by half. Between 1955-1992, the death rate was slashed by 74 percent. (ACS)
One questionable screening is the mammogram, which is basically an x-ray of the chest area. Eleven percent of the time mammograms are a false positive, which means that out of one hundred women, eleven will be told they have cancer when they don’t. For every woman’s diagnosis, 156 didn’t need a mammogram and fourteen had biopsies when later they found out nothing was there at all, (Hobson), even though most women do not find out about the effects till years later. Mammograms save some but hurt others when they would not have been harmed from any type of breast cancer during their entire life. “Not everything that looks like cancer acts like cancer,” stated by Barnett Kramer, director of medical applications of research at the Medical institutes of Health. In January the NCI agreed with a report from The Lancet, a British scientific journal, concluded, “Main studies purporting to show the benefits of mammography were so methodologically flawed that their results were meaningless.”

Knowing when to get screened is as important as the information about the tests. Every woman should start having a yearly pap smear at the age 21 and a mammogram at the age of 40.
When women go to the doctor, they are three times more likely to have their problems diagnosed as mental disorders then medical problems. The APA Diagnostic and Statistical Manual of Mental Disorders, which lists possible mental disorders for people, also lists caffeine addiction and bruxism, or teeth grinding, as mental disorders. An example of this was when the ICA (Interstitial Cystitis Association) received three letters about women over 40 years old who suffered from interstitial cystitis, (a very painful bladder syndrome), but the doctors said they had mental disorders; they eventually killed themselves.
DCIS (Ductal Carcinoma in Situ) are “microscopic cancer(s)” that are very harmful and there are many different types, and they are most commonly found in breast cancer. In 1977, there were 64 women who were misdiagnosed with DCIS and twenty years later, nothing has changed. DCIS is still as harmful now as ever before, with all the advances of technology. Women in their 40’s have at least a 30 percent chance to be told that their mammograms show something when there is nothing there at all (Napoli). So the next time a woman goes to see the doctor they should go in with as much caution as possible.
Men have just as many problems as women when it comes to overdiagnosis. One major misdiagnosed cancer is of the prostate. This type of cancer attacks the prostate and can make many everyday situations difficult for men. More than anything though, the prostate exam causes more problems than good outcomes. Sometimes it is just better to wait until the patient has symptoms to have an exam, because prostate cancer is so slow growing, half the time it will not cause death in a man’s normal life. As Doctor Andriole, surgeon at Washington University said, “It (may be) a terrific tool for helping a man access his risk for having prostate cancer. Does it necessarily mean it’s a killer cancer? The answer is no.” But if one cell comes back positive, the patient usually always chooses some kind of treatment. Treatment has its down sides though; it can cause bowel and bladder problems. Likewise hormone treatment that is sometimes used to treat prostate cancer can make weight gain, hot flashes, or even osteoporosis.
One way the doctors are able to find out if men may have prostate cancer is through a PSA (prostate-specific antigen), which means that if the level of this test is
even slightly raised doctors will think the man may have a risk of having cancer. The U.S. Preventive Service Task Force, which stated that the PSA test may be able to find cancer early, will not save any lives. The taskforce also said that for men 75 and older, the prostate exam does more harm than good. The PSA test, which has dropped the percentage of men dying from prostate cancer from three percent to 2.4 percent, has not helped the 44 percent of men that were treated when there was no need. But some ten to fifteen percent of men, ten years after they had their prostate removed, came to find out that the ‘cancer’ they had was either never there or was not life-threatening. What other choice did they have when the doctor told them they had prostate cancer? These tests have gone on long enough because it is fifty times more likely to ruin a man’s life than help it.
In 1989, a study was conducted showing that sixty percent of men, over the age of sixty, who died of other causes, had undiagnosed prostate cancer. Only three percent actually died from the cancer. The Prostate Cancer Foundation estimated that 240,000 men will be diagnosed with prostate cancer out of that, 30,000 will die of it. But 98 percent will live for five years without much trouble. There was even an autopsy that showed that out of 2,000 men, thirty percent had amounts so small they weren’t life-threatening or had no cancer at all. As Doctor David Ransohoff, professor of medicine and cancer screening at the University of North Carolina said, “I’m a little worried we may look back on the prostate era, after we learn the results of clinical trials, and see that we’ve harmed a lot of people without doing them good.”

Another important test that many men have is a colonoscopy, which looks for cancer in the colon. Men should have a colonoscopy every ten years, especially men between the ages of 50 thru 75. Likewise for any test, if there is a family history of the diseases, men should be tested. Five men out of every 1,000 will have a horrible problem after a colonoscopy, like internal bleeding, Men should think twice about the risks involved with an exam. If they are not willing to go along with other steps that may follow, they should not have the test at all. Is the risk really worth it.
Of course with women and men and even doctors, (their practice), there are many risks that follow with the screening for cancer. Something to think about is what H. Gilbert Welch, professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice said, “Screening for cancer means that tens of thousands of patients who never would have become sick are diagnosed with this disease.” This is a growing phenomenon that even has a term “Cancer without disease” stated by Judan Folkman of Children’s Hospital in Boston. Cancer as a whole is, an aging disease, and if the patient has risks such as family background or lifestyle, they should be tested. The risks of surgery can cause infertility, incontinence, or impotence. “You can say you have cancer and it won’t go away. If you’re going to operate, pick a time, do it, and move on. Or you can say its cancer, but it’s small, your young, and if we could wait three or five years without treating, great, you’ve had a chance to live through another phase of life,” said Doctor Scardino, chairman of urology at Memorial Sloan-Kettering hospital. Of course, though, if there is a family background, you have had cancer before, or you have reached a certain age, get a screen. The declines in death rates are because of better treatment not because of early diagnosis. Usually though the patients go through with the screen and most have to decide when to get or no to get the next one. As William C. Black, M.D. professor of radiology at Dartmouth-Hitchrock Medical Center put it, “Many oncologists would probably tell you that they’ve had patients who suffered serious side effects, even death from treatment that they might not have needed.” That makes anyone wonder.
Throughout this paper many people will learn that just because one cell might come back positive for cancer, doesn’t end your life with a snap of a finger. Citizens make mistakes, and believe it, not all test results are correct. Even a computer can make mistakes, but what counts is how much information a person knows so they know when and how to act. The decisions men and women make will affect their entire life, and making the wrong one can have terrible consequences. Who would want to end up as a statistic? This paper is not telling them not to be tested, or to be tested, but make sure; the individual knows what is right for them, what is ‘behind’ the results. In the end, the decision is up to the people and I hope the individuals make the right choice. No one wants to end up in murky water, unable to see the bottom.

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burningembers This work has been published in the Teen Ink monthly print magazine. said...
Apr. 14, 2010 at 8:00 pm
Wow.  You can tell you did a ton of research on this.  I agree with what you say completly...its nice to find someone who actually thinks, and doesn't believe everything that is spoon fed to them.  Great job : ) go waves!
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