Granite Geek: Think Waiting For Test Results Takes A Long Time? Try Running A Medical Study

Jan 13, 2015

Run for it, polyps! Screening tests are coming for you!
Credit e_monk via Flickr/CC http://ow.ly/HgJDR

Medical professionals have a hard time getting people to come in and get screened for various cancers and diseases.

What can be even harder, though, is finding the right screening test.

A large-scale, nearly decade-long study of two screening methods for colorectal cancer is underway. It’s  known by the acronym CONFIRM.

David Brooks writes the weekly Granite Geek science column for the Nashua Telegraph and Granite Geek.org. He wrote about the study for his most recent column and he joined All Things Considered to talk about it.

What does the acronym CONFIRM stand for here, and how will the study work?

It's sort of standing for Colonoscopy versus Fecal Immunochemical Test In Reducing Mortality.

Wow.

And what it is, is a test that's going to go on for really the next ten years - in fact, they've been working on it for the last two years, because it's a massive test. This si a test that's being done by a number of VA hospitals around the country, including the one in White River Junction, which also serves the Hanover area. They're going to be looking at roughly 50,000 veterans, to see whether colonoscopies, or another kind of streaming test called the fecal immunochemical test - which is basically looking at your feces to see if there's various stuff in there that indicates you might have cancer - to see which one of those two is better at spotting colon cancer.

The reason I wrote about this, apart from the acronym, is that it's a perfect example of how difficult it is, frankly, to know what tests do a better job of detecting which diseases in which population over which period of time.

This question of which test to use comes on top of the ongoing debate about screening as a whole.

Particularly medical screening for cancer, how much is too much, which is a quite controversial issue at the moment, with tests for prostate cancer and breast cancer in particular. Some people are saying we do way too much of it, and so we find way too many tumors that aren't really tumors, and we do way too much treatment that isn't necessary. Gilbert Welch of Dartmouth, who has written about this topic quite a lot, thinks there's really too much screening and testing of well people. He thinks medicine should concentrate on what it does best, which is treating chronic illnesses and treating emergencies - we do that very, very, very well - and spend less time looking at well people trying to find something we might need to treat.

On the other hand, there are those anecdotal stories in which people say, this treatment saved my life, which may resonate more with a potential patient than reams and reams of data might.

Absolutely, and that's a common issue in all science-based policy issues - anecdote trumps data in most people's minds. Welch is unconvinced by them - he says you don't know, in fact, that tumor would have taken your life, and you don't know whether if you had ignored it, it would have gone away, as many of them do. And you don't know whether all the treatments you did really was necessary or not. And furthermore, you don't know all the many other people who have gotten unnecessary treatment because they've done early testing. Nobody comes forward with a survivor story saying, hey, I did all sorts of stuff and it wasn't necessary.

That's why screening is difficult and answers about screening are often sort of waffley. The doctor says, well, it might help, and it might not, and the odds are sort of in your favor but not absolutely, and it's up to you. You want to only find those that need to be treated and you never want to find those who don't. For something like cancer, it's really impossible. You'll never get to that extent, so the question is, how close can you get to it? How much can you limit the number of people who get unnecessary treatment and the number of people who don't get necessary treatment, how much can you do that while still finding all those who do need treatment?

And how many great acronyms can you come up with while getting that goal?

Absolutely. If you're looking for funding, a great acronym is obligatory.