Sample English Argumentative Essay on Argument against Breast Cancer Screening

Introduction

Breast cancer screening has been a subject of debate for decades now. It has been traditionally held that cancer screening leads to early detection of cancerous cells, and, consequently, increases the chances of successful treatment. The successful treatment in turn results in a reduction in the rate of mortality associated with cancer. As a consequence this view, a lot of progress has been made within breast cancer screening. In fact, in the West, particularly North America, a lot of money has been injected into programs involved in breast cancer screening, which includes examination by oneself, examination by a specialist and mammography (“World Health Report” 94).  However, though biomedical research into cancer screening has increased medical practitioners’ theoretical knowledge surrounding breast cancer screening, it has also given rise to concerns about mammography and breast cancer examination as whole. This revelation of risks and restrictions associated with breast cancer screening has led to a debate over whether breast cancer screening weighs more in terms of benefits than harm. Recent research points to the fact all the claims that had previously been associated with cancer screening are unfounded, and that a careful examination of the issue reveals that breast cancer screening causes more harm than good, scientifically, ethically and culturally.

Scientific Argument

Unless breast cancer screening leads to a reduction in the occurrence of advanced stages of cancer, it is arguably not necessary. There are instances where advanced stages of cancer have detected in spite of the availability and actual use of breast cancer screening programs. Studies have shown that, generally, the rate of the occurrence of cancerous tumors as big as twenty millimeters continue to be observed in some patients in spite of the fact that those patients had undergone breast cancer screening (Gøtzsche 1957). The failure of breast cancer screening to curb the progress of cancer raises the question of whether at all breast cancer screening in necessary.

Furthermore, breast cancer screening has not led to any reduction of mortality related to breast cancer either. A study of women from thirty European countries revealed that though there was a reduction in the number of deaths attributed to breast cancer from 1989 to 2005 by 37% among women who were younger than fifty years, and 21% among women older than fifty years but younger than seventy years, breast cancer screening did not play any role in the reduction (Gøtzsche 1957). The fall in mortality rate related to breast cancer started before breast cancer screening was established, which means that breast cancer screening in not responsible for the reduction in breast cancer mortality rates. On the contrary, according to Gøtzsche, the fall in mortality rates is attributed to the tamoxifen, whose introduction is widely believed to explain the major decline in the mortality of young women who often have cancerous tumors that are sensitive to estrogen (Gøtzsche 1957 – 1958). Furthermore, a comparison of pairs of European countries that introduced breast cancer screening years apart did not reveal any significant differences is the rates of mortality attributed to cancer (Gøtzsche 1958). This observation bolters the claim that breast cancer screening plays very little role in the reduction of mortalities associated with breast cancer, if any at all.

Besides, it has been observed that breast cancer screening results in the detection of forms of cancer that would not otherwise be clinically detectable. This detection of clinically undetectable forms of cancers is termed “over-diagnosis.” Over-diagnosis refers to the diagnosis of forms of cancer that would not have had any effect on a woman within the woman’s lifetime (Gøtzsche 1958). It is believed in the scientific community that numerous such forms of breast cancer annually do not progress (Gøtzsche 1958). Breast screening therefore leads to over-diagnosis, and in effect results in the “invention” of patients from women who would have otherwise lived their lives free of “breast cancer” if they had not been subjected to breast cancer screening. In fact, studies have shown that most tumors that have been over-diagnosed have healed without medical intervention (as cited in Gøtzsche 1958).

Over-diagnosis does not just suggest that breast cancer screening is unnecessary, but it also presents major problems and trouble from the perspective of the over-diagnosed patient. Firstly, the over-diagnosed patient is put through the psychological suffering experienced by actual cancer patients. Cancer is still widely thought of as a terminal illness in spite of the availability of treatment for certain forms of cancers at certain stages. An over-diagnosed patient is thus subjected to unnecessary psychological suffering. Secondly, the over-diagnosed patient is put through unnecessary cancer treatment therapy. Such therapies as chemotherapy can cause significant side effects on the health of the cancer patient. The result of such unnecessary therapies is always a deterioration of the health of a healthy woman. Thirdly, over-diagnosed patients spend a lot of money on these unnecessary therapies, leading to unnecessary financial problems that may even be extend to other members of the over-diagnosed patient’s family.

Ethical Argument  

From an ethical point of viewing, “breast cancer screening” is a mere technological intermediation between the potential victim and the cancer specialist. As such, the question of technological involvement in the process raises ethical questions regarding who or what should mediate in the process of breast cancer screening, and what the origin of the mediator should be. Medical technologies are in most cases so routinely used that their repeated use engrains them within medicine. This happens so much that their use in medical care and for diagnosis becomes questionable. It is such questionability of medical technologies that gives rise to the ethical concerns over the intermediary between the potential cancer victim and the medical practitioner. For instance, the use of mammograms for breast cancer screening has been virtually standardized in spite of the fact that there exist alternative methods of breast cancer screening which have been tried and actually found to produce better results (Warner 1030)

Whatever technology is used for cancer screening, evidence reveals that there is very little connection between breast cancer screening and life-saving. According to Welch and Frankel, breast cancer screening programs account for only three fifth of detected cases breast cancer, and, of the number of cases in which cancer is detected, the measures taken thereafter benefit only thirteen percent (2044). The low number of the actual beneficiaries of breast cancer screening leads to the questionability of whether breast cancer screening in necessary at all. Furthermore, there has been an increase in the rate of false breast cancer detection, which has led to an over-diagnosis by mammograms (Welch and Frankel 2044). The rise in false positives has been observed both in women who have no breast cancer history and women who have survived breast cancer. Such false diagnosis leads to cancer therapies, which are not necessary, and the result of such therapies can cause serious implications on the over-diagnosed woman, both physically and psychologically.

Besides the failure to acknowledge that alongside benefits, breast cancer screening carries risks, it is overwhelmingly assumed that any individual diagnosed with breast cancer through screening will survive the disease. On the basis of that assumption, breast cancer screening has become widespread. This assumption, however, is never the case. In fact, according Sabel, among the few who manage to undergo surgery, one in thirty three never survive (36).

Questions regarding the origin of the knowledge applied to cancer screening measures need to be asked, in terms of both where the funding for the research comes from and who is involved in the decision making on the hypothesis to be tested in the research. The questioning is necessary because, according to Saslow et al, reports on the finding of breast cancer research are in most cases both publicly and privately funded, necessitating a questioning of how research is validated,  with the aim of fully understanding how knowledge is created and who is creating it (76). Poorly validated research may lead to such problems as poor allocation of cancer screening resources and cancer medical care. If there has to be breast cancer screening, it has to be made accessible those who need it most, if not everyone. For instance, The Task Force’s recommendation of MRI’s in Canada failed to take care of the fact that there could be a problem of inaccessibility of the new mammograms to all Canadians. This raises the ethical question of whether it is right to introduce new standards of medical care whose result is a demotion or even a complete replacement of the already established and readily available options. In fact, in lieu of questioning the rightfulness or wrongness of breast cancer screening methods, the value of measures taken to undertake breast cancer screening should be subjected to examination.

Furthermore, ethically, breast cancer screening should be subject to the same guidelines as other forms of medical technology.  Any innovation in the field of medicine must go through a number of stages, from a report that is medically promising through to a standardized medical practice procedure (Juth and Christian 164). Unlike other medical technologies, technologies used in breast cancer screening applied to breast cancer screening (the same technologies may be applicable to other areas of medicine), have not be subjected to rigors of research and testing before their application (Saslow et al 79). It is a bioethical dictation that medical technologies are up to the required standards both at the time of their first application and during the entire period of their use.  Bioethics as pertains to technology is guided by four principles: absence of harm, presence of good, consent and equality of benefits (Benner 63; Juth and Christian 172). Breast cancer screening should not be exempted from these ethical guidelines, especially absence of harm and presence of benefits.

According to Warner, any decision to subject a given patient or a given population to cancer screening should be based on a comparison between the expected benefits and the potential harm (1026). The greatest benefit as pertains to breast cancer screening is a significant reduction on the number of deaths from breast cancer, and a significant extension of the length of life of patients diagnosed with breast cancer. On the other hand, the costs of breast cancer screening are significantly high, ranging from financial investment in development of the necessary screening technologies, the cost of the medical equipment, risk of radiation hazards to psychological implication on the potential patient. The ratio of the cost of breast cancer screening to the expected benefits is not just highly unfavorable, but also, according Warner, the cost to benefit ratio is also dependent on the age of the patient in question (1026). In fact, it is possible that results obtained from previous studies substantially over-estimate the benefits of breast cancer screening (Warner 1029).  In this regard, ethically speaking, breast cancer screening is complicated. The variation across potential patients and the complication of risk-benefit assessment necessitates breast cancer examination on the basis of possible risks for each specific individual, rather than a generalization to everyone.

Cultural argument

Breast cancer screening is part of western medicine and, therefore, it is not universal; yet it is rolled out to all cultures around the world. The cultural aspect of breast cancer screening is not attributed the physiology and anatomy of the human breast as there is medically negligible variation in that respect; rather, cultural variation manifests in terms of local variations in technology, knowledge, medical practice and patient care. All these variations need to be taken into account not just with regard to breast cancer screening, but also any other form of medical practice. It is therefore necessary than any breast cancer screening program takes into account each particular context by examining the perception of illness within a particular culture, the potential social impacts of breast cancer screening to that culture, and family history. Furthermore, according to Saslow et al, there is still a general misconception that breast cancer screening will decrease the risk of catching breast cancer, which means that there is a need to take measures to reeducate on all aspects of breast cancer screening, outcomes included (83).

Culture determines community’s behavior towards and perception of many things, including medical care, under which breast cancer screening falls. The cultural aspect does not just manifest in terms of the geographical location of the community in question, but also in terms of the community’s attitude towards patients of any illness, including cancer. Women trust their caregivers, and, therefore, unless physician-patient trust is established and recognized, especially in regards to breast cancer screening, to alleviate fears around breast cancer, breast cancer screening may not achieve its purpose (Saslow et al 84). There is insufficient evidence that this cultural aspect has been taken care of, which renders breast cancer screening unnecessary as it is unlikely to achieve its full purpose.

Conclusion

            From the perspectives of science, ethics and culture, breast cancer screening has very limited benefits and high levels of harm.

            From a scientific point of view, breast cancer screening has not provided any tangible benefits. Instead, breast cancer screening has resulted in either no effect or harm in three main ways: (1) In spite of breast cancer screening, advanced stages of breast cancer have continued to be detected; (2) There is no evidence linking the fall of mortality rates associated with breast cancer to breast cancer screening; and, (3) Breast cancer screening has led to over-diagnosis, which has led to unnecessary suffering of healthy patients. The three reasons are enough to question the need for breast cancer screening.

            From an ethical point of view, breast cancer screening is not right and should therefore be reduced, if not totally stopped. First, (screening) technology, which is ethically questionable, is allowed to intermediate between the patient and the cancer specialist.  Secondly, according to medical ethics, any medical procedure should save life, which breast cancer screening does not, according to evidence. Instead, it has led to the detection of false positives. Thirdly, the detection of breast cancer through screening does not necessarily implies that the patient so diagnosed will survive the disease. Lastly, any comparison between the benefits of breast cancer screening to the risks and downsides shows that breast cancer screening causes more harm than good. This is contrary to the ethical requirement than benefits should outweigh risk/harm.

            From a cultural point of view, breast cancer screening does not take into consideration the variation of cultures across the world. The breast cancer screening diagnosis is largely based on western medicine, which means that the point of carrying it out is highly compromised within other cultures.  Unless the cultural aspects of medical care are properly incorporated into breast cancer screening, there is no point of carrying it out in other cultures as little, if anything at all, is ever achieved.

            In light of the arguments presented, breast cancer screening is an unnecessary medical procedure. It should be limited, if not completely stopped.

Works Cited

Benner, Patricia. “A dialogue between virtue ethics and care ethics.” The influence of Edmund D.

 Pellegrino’s philosophy of medicine. Springer Netherlands, 1997. 47-61.

Gøtzsche, Peter C. “Time to stop mammography screening?.” Canadian Medical Association

 Journal 183.17 (2011): 1957-1958.

Juth, Niklas, and Christian Munthe. The Ethics of Screening in Health Care and Medicine:

 Serving Society or Serving the Patient?Dordrecht: Springer, 2012. Print.

Warner, Ellen. ” Breast-cancer screening. ”  Bashai Tudu.” Tulsa The New England Journal of

 Medicine, vol. 11, 2011, pp. 1025-1032.

Welch, H. Gilbert, and Brittney A. Frankel. “Likelihood that a woman with screen-detected

breast cancer has had her “life saved” by that screening.” Archives of internal medicine 171.22 (2011): 2043-2046.

World Health Report 2012: No Health Without Research. Place of publication not identified:

 IMedPub, Internet Medical Pub, 2011. Print.

Sabel, Michael S. Surgical Foundations: Essentials of Breast Surgery. Philadelphia, PA:

 Mosby/Elsevier, 2009. Print.

Saslow, Debbie, et al. “American Cancer Society guidelines for breast screening with MRI as an

 adjunct to mammography.” CA: a cancer journal for clinicians 57.2 (2007): 75-89.