144 Comments

The older I get (early 70s) the more wary I am of all these tests--especially mammo-- for exactly this reason. Yet one is led to believe that avoiding them is un-American, incredibly risky, and will piss your doctors off such that the doctor-patient relationship is seriously undermined. I'm always looking for doctors that do not "go by the book" as one once told me. Who are open to being flexible about association-mandated testing and pharmaceutical therapies. But I understand that doctors are evaluated on how many of their patients conform to these norms, they are overwhelmed and worried about being sued for missing something, and just want to get through the day without having to have a big discussion about the DEXA or the mammo. It's really hard to decide what to do--or not do. I've been putting off the mammo and screening pelvic ultrasound for the last year or so, having been lucky enough to never need further testing so far over my many years of these tests. Most people think I'm nuts: What? Just get your mammo!

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i’m early 50s my MDs harass me because i’m done w mammo..not doing colonoscopies..paps. because im a provider they think i’m nuts!

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It feels so daring and subversive to even question it. I did have a friend who skipped her mammos for five years, then went back and did get diagnosed with breast cancer, was treated, was okay for maybe 15 years, then it came back and she died at age 69. Would she have fared better had she not skipped the mammos? Or would the result have been the same either way? You can't know for sure, right?

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I am with you. I am going to live freely. Even if I got cancer, would I do chemo? I dunno. There is the crux of it - What are you gonna do with the information once you have it?

My 52-year old friend had a colonoscopy and she had State 1 cancer. Operated. No bag, no chemo, no radiation. So there is that. And yet, I am not running out to get my colonoscopy. 🤷

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Agree with Dr. Prasad's point of view, but must tell you that mammography screening has never been abolished in Switzerland, is still recommended, and is still going strong. It is now frequently coupled with breast ultrasound.

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My Dr fired me for not getting mamograms or colonoscopies. I told her I’d get a scan of I had symptoms, but not screening scans. I was terminated from her care and she told me to get another Dr. Then THAT Dr fired me for not getting the Covid vaccine even though I was 48, healthy and, get this, had JUST recovered from a mild case of Covid.

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Which part of the country are you in? I'm in Atlanta and have seen four different PCPs since the beginning of Covid and NONE of them asked me about whether I got the Covid vax (I did get the first Covid vax, but no others). One doctor wrote me a "prescription" for a colonoscopy, but I didn't backtalk her. I just took the prescription, kept my mouth shut, and she never asked about it, or followed up with it. I also PAID CASH with all these doctors, and even though the amounts were minor ($95 to $225), I think you go to the head of the line when you're paying cash.

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You do get to the head of the line with cash. The Canadians come to the US and walk in with cash and some get knee surgery the next week. They would have to wait 2 years in Canada. US citizens on medicate - two-three months wait to get an evaluation for knee pain.

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Bravo for standing strong.

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You are far from nuts. Hang in there and do what you feel is right.

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I had a kidney "incidentaloma" in 2009. Complications from the surgery to remove it were life-threatening. Only afterward did I read Dr. H. Gilbert Welch's "Overdiagnosed" which makes the same points you are. Between 1975 and 2005 yearly kidney cancer diagnoses went from 7000 to 13,000 per 100k. Presumably all those diagnoses led to an intervention. Deaths went from roughly 4000 to....4000. So we can conclude NONE of those interventions, on average, led to saving any lives.

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But all of these interventions generated a lot of business for the medical industry. Which is the basic idea behind cancer screening and overdiagnosis.

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So 2x the diagnoses and no change in mortality value. That would imply a reduction in mortality rate wouldn’t it?

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Not unless the actual incidence of kidney cancer soared, which we don’t think happened. This stat suggests that additional diagnoses had no impact on mortality. Early detection didn’t matter.

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The rate is a percentage. Not an absolute number.

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Remember when "they" thought twilught sleep for all women giving birth was a good thing? Remember when doctors said formula was better than breastmilk? On and on... Yea, good times. And somehow we think those eff-ups will never happen again because we are so much smarter now. 🙄

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And thalidomide in PG women, and Vivoxx and Pandemrix. Let's not forget DES. Or what about the modern way of delivering babies with low forceps? So many sad things.

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And what no one is mentioning is the dangers of gadolinium contrast with MRI. It truly is a poison that does stay in your brain forever. It’s accumulative & not 100% excreted even with perfect kidneys.

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Agree. Also, beware of the “bubble” test sometimes done as part of the exercise stress test w ultrasound. The “harmless” bubbles contain Perflutrin, aka FREON-218! The perflutren can cause severe cardiac complications, btw, including death.

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Agree. Live with the assumption of health, not looking for death

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Just take fenbendazole if you’re worried about cancer. Read the Case Reports of those that eradicated their cancers with safe, inexpensive, available fenbendazole.

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This is why I don't worry too much about getting screened. Something will kill me some day. I will do something about the obvious problems (my high blood pressure) but if I feel well otherwise, that's good enough for me. I've spend too many years working in the hospital to subject myself to a life where my social life is visiting doctors and having procedures.

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Also how about we talk about Oncologists and how they profit from the chemo drugs they sell? Conflict of interest much?

This came out in August of 2023. I expected the statistics to be better.

https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2808648

Findings In this systematic review and meta-analysis of 18 long-term randomized clinical trials involving 2.1 million individuals, colorectal cancer screening with sigmoidoscopy prolonged lifetime by 110 days, while fecal testing and mammography screening did not prolong life. An extension of 37 days was noted for prostate cancer screening with prostate-specific antigen testing and 107 days with lung cancer screening using computed tomography, but estimates are uncertain.

Read the book by Otis Brawley titled "How We Do Harm"

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Says a lot about the 50 year war on cancer. It's another war we have lost...the patients that is, not the medical system and their profits.

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They always say "cure" There will never be an eradication of cancer it's makes too much money for too many people besides the fact that everyone has cancer in their bodies. It's how to keep the cancer (bad things) in your body at bay. I firmly believe it's your immune system but telling people how to boost that doesn't make anyone money.

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The American Medical System really "flourishes!" Go into any small town in America, and what's the biggest, often newest, most impressive building in town? The Hospital and "Health Center."

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It would be nice to know which percentage of tumors fall in categories #1, #2, and #3 for different patient demographics/characteristics/symptoms.

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My cancer diagnosis was 12-years ago. It was a scary time. It was also a very fun and busy time with two daughters ages 14 and 16. As expected, telling my wife and daughters of my diagnosis was truly one of the more difficult things I have ever done in my life.

Once armed with this information that you have cancer in your body, you're vulnerable. Very vulnerable. You just want it out of your body and you want to make sure any remnants of the cancer is squished like a bug under your boot.

So you talk with your surgeon and get that scheduled. Check.

And you talk with the chemo people. Check.

And you talk with the radiation people. Check.

And it became clear that each of these specialists are, well, specialists. The amount of knowledge that crosses between them seemed minimal. Red Flag #1.

And it also became clear that which ever hammer you understood and wielded (chemo or radiation), THAT was the best path forward for long life and prosperity. Yes, this is an exaggeration, but the truth is that when all you have is a hammer, everything looks like a nail. I came out of the conversations with the chemo and radiation folks not feeling convinced. Red Flag #2.

This is where trying to use reason and being pragmatic becomes really, really important. Besides surgery, the other treatment options did not sit right with me. The local practitioners I was working with did not have much experience with treating my form of cancer (testicular). Red Flag #3.

To make a long story short(er), I was very fortunate to be guided to see a physician who followed a model of "risk-adapted therapy". This was with Dr. George Bosl from Memorial Sloan Kettering. While it is probably an over-simplification, in MY circumstance, surgery was recommended but no courses of radiation or chemo would be needed (this was pending pathology results and how the cancer may or may not have been contained). I had the surgery and followed the surveillance protocol. The reason being is that if at some point in the future my cancer came back, it would be essentially just as treatable then as it was at the time just following surgery.

It jus did not make sense to apply those more drastic measures - which would compromise my health in other ways - in an effort to stomp out whatever remnants of cancer might have remained in me.

The point of this story is that while knowledge is power, that same knowledge can also be crippling and utterly disruptive to your life and your family's life. I'm not saying to stick your head in the sand when evaluating your health, but you need to be the one in charge of your health and don't be afraid of offending your health providers when you want to do your own research and seek out 2nd opinions. It's YOUR heath after all!

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This was case also w husbands colon cancer. Surgery. They suggest possibly chemo. No proof it would be helpful. But the downsides are terrible if you get neuropathy and cant drive when youre 55 say.

But some people will say- do Everything doc! This is a question of attitude and fear factor…

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Yes, you nailed it here:

"But some people will say- do Everything doc!"

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This is one of the most intelligent articles I've read concerning cancer. Thank you, Dr. Prasad!

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While I respect Dr Prasad’s argument, if the only thing one looks at it mortality you miss the benefits of therapies or surgery in many of these patients. Left unmentioned is that late treatment or surgery is often significantly more morbid with patients presenting then When treated early. It also ignores the clear evidence that treating the primary site offers benefits even in metastatic disease with breast and colon cancers.

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"..if the only thing one looks at it mortality you miss the benefits of therapies or surgery in many of these patients..."

Poes Law in action...!!

Just amazing....and not in a good way..

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Beg.pardon? That made no sense

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It made perfect sense.

I will try again.

https://en.wikipedia.org/wiki/Poe%27s_law

"...if the only thing one looks at it mortality.."

I was unsure if it was a weird parody.. by posting something so idiotic.

The only thing that counts is mortality...

What part of living or dead do you not understand?

If you still want to pretend your confused...then I cannot help you..and your probably dead...

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Ok, I'll try to use simple words for you.

As I presume you've never managed cancer patients, there are often competing priorities on how people choose what is best for them. With breast cancer for ex, through 25 years or so it's hard to show much survival benefit difference between lumpectomy + radiation vs mastectomy. However, almost 100% of women surgeons when you ask them would choose mastectomy because they want to avoid radiation, simplify screening, get better cosmetic result, and reduce the risk of in breast recurrence necessitating completion mastectomy and additional chemotherapy. NONE of those things change mortality (although I think longer follow up would intuitively show mastectomy is better at some point), but they are all valid perspectives on how treatment may be decided upon.

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The idiocy is in believing mortality is the only valuable endpoint. It's the one we (should) study in clinical trials because it is objective, impossible to fake, and in line with what a large number of cancer patients want to achieve.

An oncologist once told me that oncologists are the reason they nail coffin lids shut. But an elderly relative with a pancreatic tumor, assessed as likely curable by surgery, opted for no treatment. They had a year of reasonable quality life followed by a couple of weeks of hospice care. The alternative would have been surgical removal of much of the digestive system (itself not exactly low risk of death), lifelong complications arising from that, and likely adjuvant therapy. My relative decided that that would be worse than living their remaining time unmolested, even in the most optimistic outcome scenario.

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Vinay's proposed RCT would figure this out.

I agree with Vinay's analysis given the available information.

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Apr 22·edited Apr 22

No, it actually wouldn't as his endpoint is only looking through the lens of mortality rather then things like morbidity of treatment (early vs late). I also think some of the contention mortality isn't affected in high risk patients (rather then general populations) almost certainly has to be wrong, as at least from the breast cancer side, we can see the risk reduction benefit in action of prophylactic surgery on subsequent breast cancer development. Arguing there's no mortality benefit resulting is just implausible

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..."Modern AI and tech researchers are not much smarter than our ancestors."...you got that right. I recently read that in the US alone there are some 14 billion diagnostic tests preformed every year. That is about 40 tests for every person in the country. The outcome? We are sicker than ever and disease is running rampant.

And that begs the medical system to run even more tests. This assumes that if they find something off kilter they have the solution. More times than not, they don't and they are only guessing. Thus the need for even more tests.

I am at the point where I have lost all trust in the medical system. I will avoid all tests and take my chances with natural remedies and some prevention. If they find something wrong they want to always drug it first unless surgery is immediately required. More drugs will eventually poison you to death anyway. I prefer to let my body sort it out and I will help it along the way.

There is little assuring proof that if you engage with the medical system you will emerge healthier or live longer in a healthy state. We have been hoodwinked and lied to long enough. The doctors are all part of the con no matter how much they claim to care about patients. Shame on them all for not speaking up and growing a pair.

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Vinay is right,... basically, if you feel fine, don't run any tests... (also beyond cancer related)...

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False positives kill☠️

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Each person's thoughts on this topic seem to stem from their inner thought process, approach to life, and personal biases. There are many people (including many physicians) who can read and hear this evidence and STILL feel that screening total body MRI or general blood tests screening for cancer are a good thing! You can put as much evidence as you want in front of them and they cannot let go of what their brain tells them must be true. There are many examples in medicine of this phenomenon, from testing to treatments. And bigger picture- who is to say that the way we do things now is really the most effective or rational approach either? There are people who present themselves to doctors/medical professionals much more frequently than other people. These people will get many more "tests" over their lifetime and "things" will be found. And, yes, some people have specific medical diagnoses that require specific treatments, but many more have a whole variety of symptoms, we do a whole variety of tests, and nothing to explain those symptoms shows up. As doctors, we feel good that we've ruled out the more serious things, but in reality, we've just done a bunch of tests on someone who did not derive direct benefit - and many of these people will have an "incidental finding" that sends us down another path. The mind-body connection is unbelievably strong and certain people perceive bodily symptoms differently than others. That subset gets lots of tests. Modern medicine has very often removed any ongoing relationship between primary care doctor and patient, leading to more general anxiety on the part of patients - which in turn has them seen by medical professionals they don't know and who don't know them (ER, UC, not their primary) and this definitely drives more tests! The experience level of your doctor plays a role, the doctor's personal approach to testing, etc etc People who go in for yearly physicals get more tests. SO many factors affect who is getting "tested" and how often, what types - it is a rather chaotic and random situation. So our current, "symptom driven" approach does not have much basis in evidence either. Eventually, this will have to come down to an economic limitation. The aging population, the variety and expense of tests and treatments available. Access to health care. At SOME level, society will have to make some choices, impose some order and limitations. I'd like to believe that physicians will play a large role in how to organize some of this. Perhaps AI contributes (?) It will be interesting to see how this all plays out.

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Wise post sir!

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