I have written in the past about the controvery re the value of screening mammograms (remember that "screening" mammograms are those given to women who have not had breast cancer; the kind we get--although the test is identical--are called "diagnostic" mammograms. The distinction is important as a reminder that all of the discussion is not directed at us), but not about wider cancer screening. We hear about early detection saving lives and the parallel assumption that screening=early detection=lives saved. The more that we know, the more we sadly recognize that is not uniformly true. Of course, there have been lives saved as cancers have been found and removed or treated when they were smaller, but what really seems to matter is the biology of the particular tumor. That is, some cancers are going to be found almost no matter when they are discovered (as long as they have not yet spread) and others will be lethal even if found when they are teeny.
This is a good editorial from the New England Journal of Medicine" about this topic. It describes the decades long public health efforts to encourage us to have regular screening tests and the mixed success of this campaign.
Cancer Screening Campaigns — Getting Past Uninformative Persuasion Steven Woloshin, M.D., Lisa M. Schwartz, M.D., William C. Black, M.D., and Barnett S. Kramer, M.D., M.P.H.
For nearly a century, public health organizations, professional associations, patient advocacy groups, academics, and clinicians largely viewed cancer screening as a simple, safe way to save lives.
A simple recipe for persuasion is to make people feel vulnerable and then offer them hope, in the form of a simple strategy for pro- tecting themselves. The standard approach is to induce vulnerabil- ity by emphasizing the risk peo- ple face, often framing statistics so as to provoke alarm, and then offer hope by exaggerating the benefit (and ignoring or minimiz- ing the harms) of a risk-reducing intervention.
For example: "If you're 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. Find the time. Have a mammogram. Give yourself the chance of a life- time" (see image). This screening campaign is an example of pure persuasion. No nuance here: breast cancer is so common and deadly, and mammograms so ef- fective, that you'd have to be crazy to forgo screening.
Although the American Cancer Society ended that campaign in the 1970s, the use of persuasion is still going strong
Read more: http://www.nejm.org/doi/full/10.1056/NEJMp1209407