Early Diagnosis Is Not Prevention

Several years ago I wrote about a disturbing example of what George Orwell called "double-think" -- holding simultaneous contradictory views. At the time I focused on mammography, which has often been promoted for "preventing" breast cancer.

Mammography, however, has nothing to do with preventing breast cancer. It's a diagnostic tool. You can have a hundred mammograms performed, but they won’t prevent breast cancer. (In fact, a recent study suggested that they might even increase the risk.) Once diagnosed, a patient will usually and quickly face a medical "full-court press" with surgery, chemotherapy, and radiation.

The idea that early diagnosis equals prevention is returning. Recently, a story in the New York Times kept referring to colonoscopies as a way of "preventing" colon cancer. When I emailed the editor that colonoscopies don't prevent colon cancer, she steadfastly defended her writer's choice of the word. But again, early diagnosis is not the same as prevention. Confusing the two is double-think.

Meanwhile, a supermarket ran an ad in my local newspaper encouraging people to get various medical tests from a portable testing lab. People could pay for a "heart disease prevention package" or a "stroke and aneurysm prevention package" of tests. The tests are fine if you want them and if you want to pay for them. But they do not prevent cancer or cardiovascular diseases. They too are a form of early diagnosis.

If such tests do reveal serious health problems, then you have a choice: you can enter the medical maze and subject yourself to drugs and surgery, or you can improve your eating habits and lifestyle. But once in the medical maze -- the same one that confuses early diagnosis with prevention -- odds are that you'll be pushed toward the more aggressive and more expensive therapies. After all, the point of early diagnosis is only partly to help patients. The other part is to make money.