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If you walked past someone in the street and noticed they had a suspicious lesion on their face, would you tell them?


I guess most doctors would like to think they would, but what if you’re in a country where there is poor access to healthcare, where medical treatment is only available to those who can afford to pay for it, would that change your decision?

If you tell someone they potentially have an invasive form of skin cancer and they have no means to get it treated, surely you are doing the same as screening someone for a cancer that has no treatment.

I was faced with this very dilemma a few days ago, but I’m not in a third world country, I’m in one of the most developed countries in the world. I was on a subway train when I spotted a man with a suspicious skin lesion on his face, I took a few glances and was certain it was a basal cell carcinoma. He looked unkempt and was wearing torn, dirty clothes.

He certainly didn’t look like the kind of person to have an expensive healthcare insurance policy. I got up to approach but then hesitated, this wasn’t England, there was no NHS here, no equivalent to the free at the point of delivery, that is based on clinical need, not ability to pay system that I’m used to.

$145,000 for a 5 day hospital stay

A friend of mine, a resident of this country suddenly developed Wolff-Parkinson-White syndrome and had a 5 day hospital stay and a catheterised ablation and was charged $145,000.

I can’t even imagine that amount of money, nevertheless having to spend it for a condition that suddenly presented completely out of my control, my friend certainly doesn’t have that kind of money.

So what if you’re in this stranger’s position, what if you’re out of work and travelling on public transport, minding your own business and someone tells you that the lesion on your face, could be invading under your skin, doing irreversible damage and you have no money to pay for the treatment.

You’ve gone from oblivious to knowing that your own body is eating away at itself, and you’re powerless to stop it.

For every two lives saved through breast cancer screening one woman has unnecessary treatment according to new research.

Breast cancer screening saves two lives for each unnecessary treatment. Photograph: Yongjiet

This would come as a shock to people who believe that screening is faultless. Screening programmes do save lives but they also have disadvantages.

Screening detects the onset of a disease which gains an advantage from early treatment. In the case of breast cancer, if detected early it can be treated successfully with less aggressive management.

But to successfully diagnose the early stages of a disease there needs to be an agreed cut off for those who do have the disease and who do not. The people that test positive can then go on to have further investigations and treatment.

The problem is that having an agreed cut off means that there are people either side of the fence. People who test positive that don’t have the disease (false positives) and people who test negative that actually do have the disease (false negatives). Falling into either category can cause problems:

False positives lead to invasive tests, treatment and the associated anxiety of a cancer diagnosis.

False negatives lead to false reassurance, which can cause late presentation of a condition which may have become untreatable.

Obviously given the choice someone would rather have a false positive than a false negative, and so cut offs tend to be waited towards providing more false positives than false negatives.

So what do today’s results mean? Well although it sounds as if the new research is highlighting the disadvantage of breast screening it is actually a welcomed result.

This is because critics had claimed that for every one woman saved, ten underwent unnecessary treatment. Now women can be reassured that the screening is doing more good than harm.

Image: Youngjiet