Strong and Vital No 3

Repor tage

Live Longer Thanks to Prevention?

What is the return on investment for cancer screening? Intuitively, we all assume that an early diagnosed cancer should have a significantly better treatment success. Should. No matter in which organ the cancer begins to grow, there are slowly and rapidly growing crabs, to a certain extent turtles and hares. The turtles grow so slowly that they will probably never cause prob lems to their wearer, he dies healthy at an advanced age or from another disease. He only gets problems if this cancer is found during a preventive screening, because no preventive test can reliably predict how quickly this cancer will grow. The result: a «therapy», i.e. scalpel, radiation or chemotherapy or a combina tion thereof. Whatever, in any case, a disaster for the quality of life of a healthy person, who has become a cancer patient by chance. Then there are very fast-growing cancers, which are diagnosed because they develop symptoms. In most cases, they have already formed offshoots - metasta ses - at this stage. The «therapy» becomes a despe rate act with little chance of success. But which onco logist (cancer specialist) will tell his patient: «We can make a therapy attempt, but without any guarantee of success. Maybe we can extend life a little, but maybe we can shorten it.» The highest ambition seems to be to give the patient hope, although most of the time he has no illusions. Between the turtles and hares there is a third group of tumours (cancers), the growth rate of which is some where between the two. This means that they can be found by a cancer screening, and it is not predictable whether the patient can be cured by therapy or whe ther the early diagnosis prolongs life with cancer, but not life itself. Typical examples: the most common cancer in women, breast cancer, and the most common cancer in men, prostate cancer. There are excellent studies on the purpose of screening for these types of cancer.

After death due to cardiovascular diseases, those resulting from cancer are in second place. The diffe rence is small. The number of lost years of life (due to death before the statistical life expectancy) is high, but is unlikely to differ significantly. Why, by the way? After all, we allow ourselves super expensive healthcare systems that have built up a complex prevention apparatus for cardiovascu lar diseases and cancer prevention. Regular check ups and treatment of risk factors (of course medici nal, what else?) such as high cholesterol levels, high blood pressure or high blood sugar levels devour huge sums of money. Moreover, there are all the additional screenings such as stress and long-term electrocar diograms, echocardiograms, cardiac catheterization tests and so on... It is hard to believe that the number of car diovascular diseases does not make a noti ceable drop in this close-knit prevention offer. In other words, why life expectancy does not rise. However, we are looking in vain for the downward kink, but we find a kink: that of the health costs upwards. Health insurance companies have the task of exami ning the cost-effectiveness of medical interventions. They also do this by repeatedly put individual doctors in a bad light to the public, perhaps here and there even rightly. However, these alibi exercises have no effect on the total costs: A cost-benefit analysis for the entire prevention apparatus would be necessary.

Dr med. Jürg Kuoni

Born 1945

Curriculum vitae and contact see : strongandvital.com

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STRONG and VITAL No. 3 - 2024