Two weeks ago I tweeted that four sandbags are more helpful than lung cancer screening and that I was going to explain this to lung surgeons. After all, they will soon have to operate on this lung cancer. Quickly, people replied that they did not believe it. However, it is not complicated to explain that there are more important things than screening the population.
I used Ms. Water as an example. She had fallen while accepting a parcel for the neighbors. As she entered, she stumbled on the threshold. Luckily, this time, she didn’t break anything. She is 74 years old, but looks ten more. When she suffered a stroke in 2014, she had smoked for thirty years. Since then, she walks badly and falls regularly. Like the whole neighborhood, its front garden sank, so that the stumbling block became about 20 centimeters high. The housing association doesn’t want to raise the sidewalk.
if old people fall and break their hips, It often ends badly: six months after such a fracture, 41% of frail elderly people (thin and over 80) have died, half of the survivors can no longer go home and only 39% can go for a walk outside. Preventing falls through four sandbags under a sagging pavement therefore seems quite effective. There is simply no lobby for sidewalk sand.
The situation is different with lung cancer screening. There was already a lobby before there are any hard numbers on effectiveness. These are CT scans of people who, like Ms Water, have smoked or have smoked for a long time. We have to find them, and because nowhere does it say who smokes a lot and for a long time, we have to find something for that. In one study, Dutch researchers had to send out 600,000 questionnaires to find 15,000 people who wanted to participate. Half had CT scans, the other half didn’t.
Ten years after the same number of people died in both groups: 13.9 versus 13.8 per thousand person-years. Lung cancer mortality was lower: 2.5 versus 3.3 per thousand person-years. The researchers celebrated this as a great achievement: 26% fewer lung cancer deaths, many lives saved. Introduce this population screening. It will come, because the lobby is super loud. After all, the boss of the Rotterdam researchers, the current minister of VWS, is a strong advocate of screening the population: a few weeks after the first wave of covid in 2020 he thought that the start of population screening should be a priority† Not a word about broken or sore hips. Such a man never sees those sunken sidewalks.
The population survey displaces a real concern: in recent weeks, general practitioners have seen Ukrainian women called for cervical cancer screening because of the BSN number they have just provided. the ordinary care isn’t even organized for them, let alone trauma care. Also The Heart Foundation harasses during its collection week, overloaded GPs, through the public call to visit the GP with vague complaints, to screen whether you might have heart failure.
This remains a scourge, these lobbies clubs which stand in the way of effective care and real prevention. So only support lobbies for road sand, better education and an anti-smoking policy. Pulmonary surgeons have understood this, by the way.
Joost Zaat is a general practitioner.
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