Andy Polansky, a friend and former radiology colleague, suggested the book False Positive by Theodore Dalrymple. This book consists of the author’s comments on a year of the New England Journal of Medicine, one of the most respected medical journals. Dalrymple is British and, I suspect, classically educated since his writing is elegant and filled with classical and Shakespearean references.

One of his comments is on an article discussing rates of certain common cancers in the United States. He notes that, compared to African-Americans, Americans of European heritage have 50% more diagnoses of breast, prostate, colon and melanotic skin cancers, but the death rates from each of these cancers is approximately the same between blacks and whites.

What can this possibly mean? Dalrymple’s conclusion is the same as mine: many cancers are not clinically important, but screening, much more common in affluent people, leads to diagnosis and often treatment of cancers that will never kill you. The anxiety, complications and cost of these unnecessary treatments is enormous.

Screening in medicine is a huge, profitable business, advocated by almost all medical organizations and taught to medical students as gospel. Certain screenings are of well proven value: blood pressure in western countries or any population with a western lifestyle (societies with a mainly whole plant food diet have a very low rate of hypertension.) Screening for cancer (this does not mean looking for cancer in those who have signs or symptoms or a reason they have a high chance of a specific cancer) is problematic at the least. My personal choice was to have one colonoscopy in my late 50’s and to see a dermatologist since I am fair skinned, had a lot of sun exposure, and have had multiple skin cancers.