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Routine cancer screening can be too much of a good thing

December 1, 2009 | 11:03 am

Doctors and patients are still grappling with the notion that when it comes to cancer screening, more isn't always better. A reader from West Springfield, Mass., offered to share this cautionary tale of what happened to her when a routine test indicated she might be at risk for gallbladder cancer:

GallbladderIn August, I went through a completely unnecessary surgery that has left me with problems that I did not have prior to the surgery. About six years ago, a polyp was found on my gallbladder. I worried for about two months that I was going to die, until I finally got in to see a gastroenterologist. He told me, "We don't do anything about those. We would find those if we scanned people at random on the street. There has to be some limit." For a second or two, I wondered if he was making a cost-benefit analysis that might hurt me if this particular polyp turned out to be the rare one that was a problem. But for the most part, I stopped worrying about it, and did not think about that polyp again for several years.

Unfortunately, that doctor retired, and my new doctor was much more "conscientious." He told me we had to screen the polyp every six months to make sure it was not growing. That went on for a couple of years until one test said that the polyp had grown (although that made little sense because they told me it had "grown" to the same size that it was six years ago when it was first discovered). What followed were many agonizing months in which I tried to decide if I should have my gallbladder removed. I sought second opinions and read research concerning gallbladder cancer. It is extremely rare, but very deadly if not caught soon enough. I was frightened by "horror stories" from others who'd had the surgery and suffered adverse effects. I also heard from many people who said they felt much better after the surgery. The doctors, of course, minimized any negatives to the surgery. The only complication they informed me of was the possibility of having diarrhea for the rest of my life. But don't worry, they said, there's a pill for that.

In the end, I had the surgery done, and I deeply regret it. The surgeon found a cholesterol polyp that I could have lived with for the rest of my life. First of all, I was completely traumatized by the surgery. I was horrified that an organ had been removed from my body and sickened by the thought that someone had opened up my body and taken something out. This was an unexpected, emotional reaction that overwhelmed me for several days following the surgery and left me crying almost constantly. Of course, to the doctors, surgery is routine, but I had never had surgery before.

Now, three months later I am suffering from some problems I did not have before the surgery. A number of people, including the surgeon, have told me that I should simply be grateful that I did not have cancer. They tell me that surgery was the right decision because it is better to have the gall bladder removed than to take a chance of having a malignant tumor. I cannot agree with this logic. A certain percentage of the population -- millions of people -- have polyps on their gallbladder. Six thousand people die from gallbladder cancer each year. We simply cannot remove millions of gallbladders to prevent 6000 cases of cancer. Fortunately, most of the people who have polyps do not know about them, because their abdomens have never been scanned. Unfortunately, mine was, setting off a chain reaction of events that eventually led to a completely unnecessary surgery.

Why was my abdomen scanned six years ago? My primary care doctor was performing a routine physical, pressing down all over my belly and abdomen asking me if I felt any tenderness. I did not know how to answer. My abdomen is lean (and extremely ticklish). I was not sure how to distinguish between “tenderness” and the normal pressure anyone would feel during such an exam. During one of her many presses, I answered yes, that I felt some tenderness. She immediately ordered a test. I thought about canceling, as I was in no real pain, but I didn’t. I went ahead with the scan, and that is how the polyp was first discovered.

-- Karen Kaplan

Photo: Doctors performing laproscopic gallbladder surgery. Credit: Allen J. Schaben/Los Angeles Times