Selling screening

‘Selling screening can be easy. Induce fear by exaggerating risk. Offer hope by exaggerating the benefit of screening. And don’t mention harms. It is especially easy with cancer — no diagnosis is more dreaded. And we all know the mantra: early detection is the best protection. Doubt it, and someone may suggest you need your head examined.

“If you are a woman over 35, be sure to schedule a mammogram. Unless you’re still not convinced of its importance. In which case, you may need more than your breasts examined.” Old American Cancer Society Poster.

Messages selling screening are everywhere. The news regularly tells the story of celebrities asserting that their lives have been saved because of the early diagnosis of a cancer. It is very unusual to hear stories of those injured by overdiagnosis and overtreatment. Popular magazines report emotionally charged but wholly unrepresentative stories about young women with breast cancer and their fears of dying and leaving their young children.

Medical centers use screening as a business strategy, offering free tests to attract patients. Public service announcements — like the American Cancer Society’s slogan above — speak for themselves.

Woloshin S, Schwartz LM. Numbers needed to decide. Journal of the National Cancer Institute 2009;101:1163-65.

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