EARLY DETECTION

Ratner and Bonislawski argue that the American way of cancer detection is all wrong.

Ratner, a board member for Weill Cornell Medical Center and the Memorial Sloan Kettering Cancer Center, is perfectly placed to advocate for a variety of reforms. “Early detection, a critical solution to the cancer epidemic, is hiding in plain sight,” he writes in this co-authored book. Rather than await the diagnosis of an illness when it is well developed and thus often expensive to treat—to say nothing of the treatment often being only a strategy to buy time—it would be better to “shift the emphasis to early detection of cancerous growths, until now the poor stepchild of the whole process.” This will require the redirection of research funding, only a small fraction of which goes to early detection. As the authors note, it will also require a persuasion campaign to get Americans to the doctor for those early tests; an early-warning lung cancer screening now in place is little used, in part, perhaps, because medical staff aren’t pushing it. Where tests have become standardized, they have shown remarkable success: The authors write that the Pap smear, for instance, “has arguably done more than any other single intervention to cut cancer deaths,” but it’s sobering to consider how long it took for it to be used widely—even more sobering to note how the medical and insurance establishments relegated interpreting the test to poorly paid, overworked women staffers. Other forms of cancer can be just as effectively treated if caught early, and the authors identify many unaddressed pieces of the puzzle, not least that “doctors must be highly proficient in cancer screening literacy” so that patients understand what’s happening—a matter for which they offer additional advocacy.

A lucid, persuasive case for overhauling diagnosis regimes to catch cancer early rather than late.