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Comments on prostate/breast cancer “Screening is like gambling” (H. Gilbert Welch, NYT, 10-11-2011)
The statistics reported in the article are quite clear but the conclusion, that there are “winners and losers,” leave us at a fork in the road regarding screening of a specific patient. Like all travelers facing a fork in the road, it’s not the bifurcation in the road that makes the ultimate difference, it’s the traveler. Accepting this perspective changes how one can go forward.
Gambling simply indicates a chance, a coin toss in a sea of uncertainty which is not quantifiable; risk, on the other hand, is. When facing any such decision/fork in the road, we should convert as much of the uncertainty into a quantifiable risk by fully utilizing some of our senses that are situation-appropriate and experientially-confident. In addition, understanding the traveler and his/her environment, up to the junctional point of the road, is vitally important. Systems science perspective allows a peak into that conundrum through probing questions: where is the traveler now and has s/he been manifesting adaptation and evolution in their lives? Both functions are key characteristics of a well-functioning (bodily) system.
Cancer represents a degree of bodily system’s dysfunction, either at a local level, a sub-system failure of adapting and evolving, or a full systemic failing. It may be possible for doctors and patients, to jointly lift the veil on the patient’s current bodily system’s status, because patient’s history, symptoms and signs do indicate the degree of existing quantifiable risk thus diminishing the overall uncertainty of the “fork-in-the-road-decision,” in this instance: should s/he be screened or not? Those patients, whose bodily systems are judged not to be adapting and evolving, should be strongly considered for screening; others could pass.
The subsequent question that needs to be answered is: if not present, then how likely is the patient going to return his/hers bodily system to sustainable adapting and evolving, as that will have great influence on the long-term outcome of treatment for any discovered cancer?
Overall, with systems science, the question of screening would seem to be less of a gamble than the statistics would indicate.