Scuba and screening

Every day, we each make choices. Some choices are pretty obvious and require little discussion or thought; for others, individual preference plays a major role with different people making different choices based on different perspectives.

A personal example involves a trip my wife and I plan to take to a warm, seaside location in January. One choice is whether we will use sunscreen. This is a “no-brainer.” Another choice is whether we should go scuba diving.  I love scuba diving and jump at every chance I get to spend time swimming with the colorful fish of the underwater world. My wife makes a very different calculation. Factors that impact on her decision include being in cold water, breathing through a small rubber tube, and the thought of being in the water with potentially nasty creatures.  When it comes to sunscreen – the choice is obvious. When it comes to scuba diving, we each made our own calculation based on our own perspective.

One might think that the decision as to whether to get screened for cancer would always fall into the “obvious” category since we know many cancers are more easily and effectively cured if they are found early. Indeed, there is consensus on some approaches to cancer screening that is clearly indicated. Examples include mammography for women 50-74, pap smears for women 21-65, and some form of colorectal cancer screening between ages 50-75.

However, as with most things in life, there is also a gray area. Even very accurate medical tests have a false positive rate. For cancer screening tests, a false positive result suggests the presence of a cancer when in reality there is none. A false positive cancer screening test can result in additional medical intervention (with its associated risks, long term side effects, and costs) not to mention anxiety for the patient. In addition, we are learning that some early cancers, particularly in older individuals, are unlikely to impact on the duration or quality of life. For some people, finding and treating an early stage cancer early can do more harm than good.

An example of the gray area in cancer screening where personal preference is important is PSA testing. After considering all the variables, some men determine they would choose definitive therapy if an elevated PSA found on screening leads to discovery of an early stage prostate cancer. For such men, the screening test is appropriate. Other men, after considering overall health, concerns about side effects of therapy, or other personal preferences, would not seek treatment if an early stage cancer is detected. For these men, there is no point in doing the screening.

Determining whether to be screened when in the gray zone is difficult, and a discussion with a doctor before the test is done is key. In addition, for those who want to review the information on their own, a number of groups have issued guidance and guidelines related to cancer screening, including the National Cancer Institute (http://www.cancer.gov/cancertopics/screening), the Centers for Disease Control and Prevention (http://www.cdc.gov/cancer/index.htm), the American Cancer Society (http://www.cancer.org/healthy/findcancerearly/cancerscreeningguidelines/), and the U.S. Preventive Service Task Force (http://www.uspreventiveservicestaskforce.org/adultrec.htm#cancer ) .

How about my wife and me? We have considered the pros and cons as we each see them, and have made our choice ahead of time. We both will use sunscreen (just like we both have been screened for colorectal cancer). My wife will stick to a beach towel and a book, and I will bring a mask and fins, since for me, the colorful fish outweigh the gray zone of sharing the water with potential nasty creatures every time.