Judges’ comments: Kate Pickert asks the multimillion dollar question … “Are some cancers better left undiscovered?’ As she powerfully illustrates, simply asking the “C” (cancer) question can be life threatening and is big business for powerful sectors of the U.S. health care industry. Pickert points out that it may be better off to not find some answers, given that many cancers are inconsequential and the impulse to treat is so great.
This article raised important issues about a number of tests and broke new ground by looking at several screening protocols that are on the rise and might save one life while harming thousands of others, forcing many to endure myriad unrelated interventions to treat innocuous findings.
Time used strong graphics to drive its points home and left readers with solid advice on which tests readers should undergo and gave important questions to ask before screenings.
List date(s) this work was published or aired.
13-Jun-11
See this entry.
Provide a brief synopsis of the story or stories, including any significant findings.
This story explores the perils of cancer screening and was an anchor piece for a package of cancer stories TIME published in a June 2011 issue. Screening, the process of searching for cancer in asymptomatic people, is something most Americans consider life-saving, but I pulled back the curtain to explain to consumers this is not always the case. Screening can, in fact, be life threatening and is big business for powerful sectors of the U.S. health care system. It may be better not to find some cancers at all, given that many are inconsequential and the impulse to treat them with surgery, radiation or chemotherapy is so great. While other journalists have previously written about the drawbacks of a popular test to screen for prostate cancer, for instance, I broke ground by delving into the entire cancer screening apparatus and looked at other misguided screening protocols that get far less attention. Thyroid cancer is often described as being “on the rise,” but with evidence, I explained that more people are being diagnosed, but the mortality rate is not changing. Thyroid cancer screening is merely leading to unnecessary treatment. With this type of cancer, as with others, tumors themselves are usually not even dangerous. In fact, as I explain in The Screening Dilemma, it’s possible that, technically, we may all have cancer of some kind. It’s unsettling to imagine living with undetected cancer, so it takes a well-researched and clearly written story to convince people this may be the best course. I believe I achieved that with The Screening Dilemma.
Explain types of documents, data or Internet resources used. Were FOI or public records act requests required? How did this affect the work?
Cancer itself is an emotional topic and so I felt it imperative to rely heavily on data to differentiate between worthwhile cancer screening, useless screening and screening that might save one life while harming thousands of others. I read nearly all of the sound existing medical literature on cancer screening, focusing on randomized double-blind studies looking at cancer screening effectiveness. These included everything from the wide breadth of data on breast cancer screening and treatment to preliminary results of the National Lung Cancer Screening Trial, which included data on more than 53,000 smokers, to studies on the effectiveness of screening infants for neuroblastoma in Japan and Quebec in the 1980s and 1990s. Using Excel spreadsheets, I compared mortality and diagnosis rates for every major category of cancer, drawn from data compiled by the National Cancer Institute. This allowed me to evaluate the effectiveness and associated harms of various kinds of screening. Alongside the text of my story, we used graphs and charts to illustrate for readers which cancer screening saves lives and which does not. Based on guidelines published by the U.S. Preventive Services Task Force, we also offered consumers advice about what kinds of screening they should undergo, in an effort to urge patients to ask questions before undergoing screening and possibly avoid tests that are unlikely to benefit their own health.
Explain types of human sources used.
I relied on the insights of some of the foremost experts in cancer research in America, including the chief medical officer of the American Cancer Society and the former associate director for disease prevention for the National Institutes of Health who is also a noted oncologist. Yet, in addition, I found an Oklahoma family doctor who authored an influential essay in the New England Journal of Medicine in 1986 warning of the dangers of unnecessary medical intervention. Decades later, this doctor found himself on the other end of a negative prostate screening test unable to resist the intervention– prostate removal surgery – he had warned others to be avoid. He shared this personal story with me. I also extensively epidemiologists who study cancer screening with an unbiased eye and I talked to countless oncologists and radiologists about how cancer screening influences treatment.
Results (if any).
In the months following publication of The Screening Dilemma, other outlets followed my lead, including the New York Times magazine which ran a story in October 2011 called Can Cancer Ever Be Ignored? This story was, idea-wise, a replica of my TIME piece. In addition, since The Screening Dilemma, evidence has emerged to vindicate the work by further proving that cancer screening has gone too far in America and needs to be studied more extensively, with public policy based more on evidence and less on politics, emotion and profit. Also in October, an influential government panel said men should no longer receive a widespread prostate cancer screening test, reversing decades of routine medical practice.
Follow-up (if any). Have you run a correction or clarification on the report or has anyone come forward to challenge its accuracy? If so, please explain.
No corrections were needed.
Advice to other journalists planning a similar story or project.
See beyond superficial numbers if you want to offer advice to consumers about how to take care of their health. This is too important a subject not to. Don’t be swayed by claims of breakthrough treatments – check out the data yourself before you type a single word. For example, the “five-year survival rate” for a certain disease may be higher in the U.S. than in the UK. But this is meaningless. It may only be higher because the disease gets detected *earlier* in the U.S. Know the difference between a good randomized trial and a study that shows correlation but not causation or one in which patient self-select which treatments or tests they get. And most of all, beware of disease trends in medicine publicized by parties that have a vested interest or profit motive in increased awareness.