Data shows that, not surprisingly, cancer screening took a hit during COVID. This even applied to bowel cancer screening which, compared to breast or cervical cancer screening does not require one to attend a facility outside the house –unless one counts a post box as a facility. The question that is unanswered and may never be is what impact this will have on morbidity and mortality over the next decade or two.
Conventional thinking would tell us that the lost opportunity to find a cancer early, once lost can never be regained. In fact, by definition, a cancer found later is not found early. However, there is a school of thought that in some instances we are over diagnosing indolent lesions, which would not impact the person during their lifetime if not found.
Screening for cervical cancer was changed to five yearly and started later due to the view that too many women were undergoing colposcopes and other procedures that they ultimately did not need. Critics have pointed to the number of men who die with, not of, prostate cancer detected on routine PSA testing.
History tells us that when we believe today has a fair chance of being shown to be wrong at a future point in time. The term ‘ontological shock’ is defined as the state of being forced to question one’s world view.
This is something we tend to resist in medicine. A recent study suggested that opiates may be no more effective than placebo in treating neck and back pain. Most of the commentary was critical of the study. There may be valid grounds for criticism. It was a small study and seems counterintuitive. Yet the latter is why we should be very curious as it creates ontological shock. What if our world view on use of opiates is wrong?
The term ‘ontological shock’ is defined as the state of being forced to question one’s world view.
Dr Vinay Prasad writing in Sensible Medicine describes the case of a 74-year-old man who enjoyed smoking cigarettes (I know!) and tinkering on cars. Routine screening had found a lung cancer. “I have never felt bad in my life except for what you doctors did to me,” the patient said.
Prasad notes: “The only thing we know for sure is we gave a man side effects and kept him from doing what he loves. What we have no idea is whether he is better off.”
A genuine ontological shock will come if we find cancer morbidity and mortality does not rise as we expect with reduced screening. Time will tell.
health wants and needs of all. There will be gaps. The challenge is to be honest about it.