Should I Be Tested for Cancer?: Maybe Not and Here's Why (Hardcover)

by H. Gilbert Welch (Author)

Editorial Reviews

From The New England Journal of Medicine
In the absence of well-reasoned skepticism, medical practice can become enraptured with the potential of new technological advances. In this insightful how-to book on health care, Welch provides a comprehensive overview of current challenges in cancer screening. He draws from published literature, case histories, and his own medical practice in discussing the risks and benefits of screening, thereby exposing the true limits of current technology and of our knowledge as to how and when to intervene against early neoplasia. This comprehensive book has two parts, "Problems You Should Know About" and "Becoming a Better-Educated Consumer." Part I lays out the premise for early detection and gauges the risks and benefits that most people might derive from screening, given their susceptibility to cancer and the competing causes of illness and death. Part II details the practice of early detection and instances in which nonmedical factors -- such as human vulnerability, social forces, and fear of litigation -- have sometimes led to overzealous adoption of unevenly effective techniques for cancer screening. A comprehensive index accompanies the text, along with useful commentary that expands on and qualifies selected excerpts. Welch's lucid presentation of complex and timely issues is an achievement in itself, but even more, this is an eminently readable book that is bound to inform and complement the ongoing debate about screening. The author maintains that cancer screening may have been oversold to the public and health care practitioners alike. By challenging commonly held assumptions, Welch stimulates a critical dialogue between patients and providers regarding the effect of screening on cancer-associated morbidity and mortality, the sequelae of false positive results, and the slippery slope of diagnosing and managing incidentally detected cancers, many of which may pose no immediate health threat. To balance this cautious approach to cancer screening, the author acknowledges the successes of rigorously proven screening methods and weighs them against the high costs that invasive cancer imposes. Indeed, leading health economists recently estimated that as little as a 10 percent reduction in cancer would translate into a savings of $4.4 trillion to society. This book, which offers a sobering view of the status of cancer screening today, deserves to be widely used by patients and providers as they navigate an expanding and often bewildering array of screening options. Nevertheless, improvements in our understanding of carcinogenesis, enhanced performance characteristics of early-detection technology, and noninvasive approaches to diagnosing early neoplasia are likely to narrow the gap between the detection of disease and its appropriate medical management. These advances are likely to recalibrate the risk-benefit ratio of cancer screening. Indeed, transient uncertainties and potential harm should serve as an impetus for scientific advancement, rather than as evidence of conceptual failure. In an evolutionary sense, the dilemmas so well detailed in this book may be viewed as natural preconditions for continued progress. Jaye L. Viner, M.D., M.P.H.
Copyright © 2005 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.

From Booklist
The cost of medical malpractice soars as patient lawsuits proliferate, and healthcare providers react with rounds of "defensive testing" that boost insurance costs. Add to those trends "early detection" as the watch(buzz)word associated with the most dreaded of diseases, cancer, and you have Americans possessing health coverage routinely undergoing test after test. What of the downside of testing healthy people? Welch, a specialist in cancer detection, challenges common knowledge about everyday screenings, such as mammograms and PSA (prostate specific antigen) tests, citing patient anecdotes and research data on the most commonly diagnosed cancers in this readable, thought-provoking book. He argues that of the two basic cancer-prevention strategies--health promotion (diet, exercise, etc.) and early detection--the latter is the easier sell, and he notes that most tested people never develop cancer; screenings tend to miss the fastest-growing, most deadly cancers; and cancer-free patients with abnormal screenings often endure seemingly endless, sometimes risky testing that leads to unnecessary treatment. Accessibly written, Welch's perspective provides needed balance to current emphasis on testing. Whitney Scott
Copyright © American Library Association. All rights reserved

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Product Details

• Hardcover: 234 pages
• Publisher: University of California Press; 1 edition (March 10, 2004)
• Language: English
• ISBN-10: 0520239768
• ISBN-13: 978-0520239760
• Product Dimensions: 9.2 x 6.3 x 0.8 inches
• Shipping Weight: 1.1 pounds (View shipping rates and policies)
• Average Customer Review: 4.9 out of 5 stars See all reviews (19 customer reviews)
• Amazon.com Sales Rank: #170,417 in Books (See Bestsellers in Books)

Customer Reviews

Most Helpful Customer Reviews

38 of 38 people found the following review helpful:

5.0 out of 5 stars Cancer Screening is Not Always a Good idea, March 6, 2004

By	Robert M. Kaplan (Del Mar, California) - See all my reviews

For decades, the American Cancer Society and others have relentlessly campaigned for early cancer detection. And the campaign has been successful - the Journal of the American Medical Association recently reported that only 2% of Americans felt that there are too many cancer-screening tests. Despite this enthusiasm, expert panels of physicians and scientists, after careful reviews of the evidence, do not always endorse screening. Facing these conflicts can be distressing, particularly when confronting issues as serious as cancer.

This book offers insights that clarify the issues for patients and physicians alike. As the subtitle suggests, Welch is skeptical about screening, and his text challenges the establishment. However, Welch is not a medical outsider. He is a practicing physician, a Professor at the Dartmouth Medical School, the former editor of a medical journal, and a researcher who has helped reshape professional thinking in articles in the New England Journal of Medicine, Journal of the American Medical Association, Annals of Internal Medicine, and other key medical journals. Using the traditional medical literature, Welch raises some very challenging questions for anyone considering cancer screening.

Welch's book provides the reader with a new way to think about testing. He tells how cancer tests may identify disease for which there is no effective treatment, or for which the consequences of treatment are worse than the consequences of the disease. Welch explains why it may sometimes be better not to know you have cancer. In fact, many of us have conditions that will never affect us. In one section, he uses data from the pathology literature to demonstrate how fuzzy the definition of early cancer realy is - that different pathologists can examine the same specimens and come to different conclusions about whether cancer is present. Another section offers easy rules that clarify misleading reports of cancer rates. By walking us through the meaning of cancer statistics for individual patients, Welch clarifies what numbers should be important to individual patients.

The bottom line is that this book takes on a difficult topic with remarkable clarity. Dr. Welch provides tools that will help patients play a more active role in their own health care decision making.

Robert M. Kaplan is Professor and Chair of the Department of Family and Preventive Medicine at the University of California, San Diego School of Medicine.

35 of 36 people found the following review helpful:

5.0 out of 5 stars Clear Expose of The Cancer Industry, May 24, 2004

By	Joel M. Kauffman (Berwyn, PA United States) - See all my reviews (REAL NAME)

H. Gilbert Welch, MD, MPH, has written an unusually understandable revelation of the folly of testing for cancer in people with no symptoms. He explains how only a few people will benefit from common tests such as PSA, fecal blood, mammograms and others. He is enough of an insider to be able to explain the flaws in clinical trials being used by "authorities" to recommend extensive testing, and the lack of trials in some cases. The unneccessary biopsies, surgeries, radiations, chemotherapies for slow-growing cancers or even non-malignant ones are presented bravely. The uncertainty of testing is exposed where a positive for cancer may be wrong 1/3 of the time. And it is up to the patient to get second opinions.
The financial and legal pressures on MDs to test excessively are brought out. There is advice on talking or writing to your MD to indicate your unwillingness to undergo too many tests, and not to hold your MD liable if a cancer was "missed" - that is the big thing.
The deaths caused by cancer treatment are aired. This is something very few people, even MDs, know. Even when a treatment can cut the deaths from a particular cancer in half, most current treatments create non-cancer deaths, many of which will be improperly reported.
Welch is a special expert on the misleading nature of 5-year survival rates how they can rise because of early detection, yet with no change in the cancer plus cancer treatment mortality rate.
There are good explanations of how 5-year survival rates are calculated, how age-adjustments are made, how randomization for trials is done, and other things not even taught in medical school, but reserved for medical researchers. And quite easy to comprehend with clear figures and tables.
No errors that I can find; a really excellent book.

39 of 41 people found the following review helpful:

5.0 out of 5 stars Extremely Valuable Book, April 20, 2005

By	Concerned Citizen - See all my reviews

Should I be Treated for Concer? Maybe Not and Here's Why, by H. Gilbert Welch

It is hard to put into words the importance of the book, Should I be Tested for Cancer? by Gilbert Welch, M.D., Professor of Medicine at Dartmouth Medical School. It is equally as hard to put into words the courage that it must have taken to write this book. The medical establishment does not look kindly on those who stray too far from the constraints of conventional wisdom. Those of us who seek only about the truth as it pertains to healthcare issues are greatly indebted to Dr. Welch for daring to do so.

I have been involved with health care issues for over 28 years. This book is a God-sent and is easily the most important book on this subject I've read in the last decade. Quite frankly, I couldn't put it down. It was given to me by one of my patients who, over the years, has known of my "healthy skepticism" towards many aspects of conventional medical practice, especially as it relates to cancer diagnosis and treatment. The book confirms many of the thoughts that I have shared with my "nontraditional" patients over the years.

It is never easy to be perceived as going against the grain of conventional wisdom in any discipline, especially one as emotionally charged as cancer. The author has performed an invaluable service to the many concerned people who dare to think for themselves "outside of the box." A simple perusal of some of the chapter headings reveals all you need to know about where the book is headed: "It is unlikely that you will benefit." "You may have a `cancer scare' and face and endless cycle of testing." "You may receive unnecessary treatment." "You may find a cancer you would rather not know about." "Your pathologist may say it's cancer, while others say it's not." "Your doctor may get distracted from other issues that are more important to you."

In Dr. Welch unemotional, factual writing style, we learn about such concepts as "false positives," "pseudo disease," the fallacy of "early detection," suspicious and unreliable "cure rates." We are introduced to the rarely recommended but legitimate treatment option of "watchful waiting" which, for many patients and some forms of cancer, may be the best course of action. We are told that how hard doctors look for prostate cancer affects how much they find. Did you know that there is a saying among doctors about prostate cancer: more men die with it than die from it? There are similar nuggets of wisdom about breast cancer, cervical cancer, and lung cancer. And did you know that you could easily become a victim of a deadly form of medical "political correctness"?

Here are a few snippets from the book well worth quoting:

"Tests can be wrong, people are made to worry unnecessarily, some are treated unnecessarily, and some are even harmed by treatment."

"I will argue that a decision to forgo cancer treatment can be a reasonable option."

"If the behavior of doctors and the public continues unabated, eventually every well person will be labeled as sick."

"Some believe that anyone who dies of cancer and wasn't screened would have been saved had they had a test. But that's not true."

"I object to the emerging mindset that patients should be persuaded, frightened, and coerced into undergoing [mammography, PSA tests, fecal occult blood testing]. There is today a certain "medical correctness" about screening - making patients feel guilty if they choose not to pursue testing. This is wrong." [emphasis added]

As Dr. Welch makes abundantly clear, this book is not for everyone. It is not for people for have a need for simple answers. We all know friends and relatives who, if told they have a "lump" somewhere on their body, need to "have it out" as soon as possible in order to restore a certain peace of mind. This book is definitely not for them. Rather, it is for those thinking individuals who are open to questioning the wisdom of traditional medical practices, especially as they pertain to cancer testing and conventional treatment modalities. For them this book is a definite eye-opener and may someday become a life-saver. Again, one can only admire the courage that it took to write a book of this magnitude.

I enjoy the give-and-take of discussing health issue with my patients. While I refrain from offering specific medical advice outside of my field of dentistry, I readily discuss health issues on a general level with selected patients. What I always suggest is that it is extremely important that they educate themselves in all aspects of healthcare - including cancer diagnosis and treatment - now, when they are healthy, so that when the day comes when they or a loved one are confronted with an important health issue, they can make an intelligent , informed, and unemotional decision. This book has greatly assured me that this is a sound, reasonable philosophy, and as such, I will be highly recommending this book to all those who want to be actively involved in their own healthcare decision-making process.