Context Public health officials, physicians, and disease advocacy groups have
worked hard to educate individuals living in the United States about the importance
of cancer screening.
Objective To determine the public's enthusiasm for early cancer detection.
Design, Setting, and Participants Survey using a national telephone interview of adults selected by random
digit dialing, conducted from December 2001 through July 2002. Five hundred
individuals participated (women aged ≥40 years and men aged ≥50 years;
without a history of cancer).
Main Outcome Measures Responses to a survey with 5 modules: a general screening module (eg,
value of early detection, total-body computed tomography); and 4 screening
test modules: Papanicolaou test; mammography; prostate-specific antigen (PSA)
test; and sigmoidoscopy or colonoscopy.
Results Most adults (87%) believe routine cancer screening is almost always
a good idea and that finding cancer early saves lives (74% said most or all
the time). Less than one third believe that there will be a time when they
will stop undergoing routine screening. A substantial proportion believe that
an 80-year-old who chose not to be tested was irresponsible: ranging from
41% with regard to mammography to 32% for colonoscopy. Thirty-eight percent
of respondents had experienced at least 1 false-positive screening test; more
than 40% of these individuals characterized that experience as "very scary"
or the "scariest time of my life." Yet, looking back, 98% were glad they had
had the initial screening test. Most had a strong desire to know about the
presence of cancer regardless of its implications: two thirds said they would
want to be tested for cancer even if nothing could be done; and 56% said they
would want to be tested for what is sometimes termed pseudodisease (cancers growing so slowly that they would never cause problems during
the persons lifetime even if untreated). Seventy-three percent of respondents
would prefer to receive a total-body computed tomographic scan instead of
receiving $1000 in cash.
Conclusions The public is enthusiastic about cancer screening. This commitment is
not dampened by false-positive test results or the possibility that testing
could lead to unnecessary treatment. This enthusiasm creates an environment
ripe for the premature diffusion of technologies such as total-body computed
tomographic scanning, placing the public at risk of overtesting and overtreatment.