Joshua J. Ofman and Azra Raza in Scientific American:
Improving early cancer detection may be the only way to really put a dent in the cancer mortality curve; however, early cancer detection is suffering from a common ailment in medicine and public health: the streetlight effect. We are looking for five cancers “over here” under the streetlight where we have early detection tests, but about 70 percent of cancer deaths are occurring “over there,” in the dark, where we aren’t even looking. Some may assume that we aren’t screening for these cancers because we don’t have treatments, but a review of practice guidelines and the literature shows that nearly all early cancers have effective treatments, even if watchful waiting is recommended for some, such as nonaggressive early prostate cancers.
Patients don’t get to choose which cancer they get. So, what if we transition away from screening for individual cancers, and start screening individuals for all possible cancers? What if we dramatically improved overall cancer detection? What if we shifted to tracking the cancer detection rate (CDR) in the population?