Posts Tagged ‘American Cancer Society’

PROSTABLOG NZ: It’s almost a year since the first hearings were held by the NZ Parliament’s Health Select Committee inquiry into the early detection and treatment of prostate cancer.

The obvious question now is when will it report back.

Since it published its terms of reference in August last year, the committee has received 33 submissions, four of them from the influential health lobby group, the NZ Guidelines Group, whose last submission was made in December.

This document made it clear that the group – an independent incorporated society originally set up by the government in 1996 – is opposed to population-based PSA screening.

To save one life, up to 41 men could incur significant harm.

It bases this view on its assessment of numerous NZ and international studies, including two large randomised trials (one European, the other American) that were reported last year.

Here are some of the last pages of the group’s December, 2009, submission (RCT = random controlled trial):

This also appears to be the main thrust of submissions on PSA testing from other health authorities (although the Guidelines Group is at pains to stress it is independent from the Ministry of Health).

Another “official” organisation, the National Health Committee, said in its submission (August 26, 2009) that it has seen nothing to change its 2005 advice to the MOH that population-based PSA screening is not an acceptable option.

However, it did favour targeted screening of high-risk groups, such as men with a family history of prostate cancer.

The NHC is aware that since providing its advice in 2005, clinical practice has found
that targeted screening for men at high risk of prostate cancer appears to be useful
and potentially cost effective. These are men who have a family history of prostate
or related cancers.

The Royal NZ College of General Practitioners – presumably speaking on behalf of doctors on the frontline – said in its submission it would go along with the NZ Guidelines Group’s views.

It did make a couple of pleas, however, calling for up-to-date information to hand out to patients, and for treatment to be available to all:

It is important that inequities in access relating to follow up after positive
screening results, and for symptomatic men, are identified and eliminated.

The Cancer Society agreed with the Guidelines Group, and backed this up by quoting from selected organisations in other Western countries.

Most agencies around the world have some form of recommendation that decisions for screening for prostate cancer should be made on an individual basis and in consultation with a medical professional:

The Australian Cancer Council states that:
“In the absence of direct evidence showing a clear benefit of population based screening for prostate cancer, a patient centred approach for individual decisions about testing is recommended. Screening discussions and decisions should always include and take into account, age and other individual risk
factors such as a family history of the disease” (Cancer Council Au 2005).

The American Cancer Society states that:
“The American Cancer Society (ACS) does not recommend routine testing for prostate cancer at this time. ACS believes that doctors should discuss the pros and cons of testing with men so each man can decide if testing is right for him. If a man chooses to be tested, the tests should include a PSA blood test and
DRE (digital rectal exam) yearly, beginning at age 50, for men at average risk who can be expected to live at least 10 more years.” (American Cancer Society 2009).

The UK Cancer Research Council states:
“in the UK, there is no national screening programme for prostate cancer because trials have not yet shown clear evidence that screening will reduce deaths from this disease. Also, many men diagnosed with
prostate cancer have very slowly growing cancers that will never cause any symptoms or problems in their lifetime. So at the moment there is no clear benefit in diagnosing prostate cancer early and it may actually cause harm for some men.”(Cancer Research UK 2009).

Urological Society of Australia and New Zealand states:
“Individual men aged 50 to 70 years with at least a 10 year life expectancy should be able to be screened by annual DRE and PSA testing, after appropriate counselling regarding the potential risks and benefits of investigations and the controversies of treatment.”(Urological Society ANZ 1999).

The majority of submissions – from prominent medical practitioners, prostate cancer lobby groups and patients – urged the committee to recommend PSA testing, if not on a population (all men) screening basis, then at least as a service offered routinely by GPs, without men having to ask (the current MOH policy).

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ABC 15.COM: Cancer accounted for nearly $1 trillion in economic loss worldwide due to premature death and disability, says the American Cancer Society. That’s 20 percent larger than the number two cause, heart disease. READ MORE>

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FOOD CONSUMER: Male cancer deaths in the US dropped 2% between 2001 and 2006, reports the American Cancer Society, which attributes the decline to people giving up smoking, better cancer treatment, and earlier detection. READ MORE>

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WOWT.COM: The American Cancer Society is helping newly diagnosed prostate cancer patients through their Man to Man Peer Support Programme. READ MORE>

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URO TODAY: The American Cancer Society updated its recommendations on prostate cancer screening after a series of reviews. READ MORE>

It says:

Prostate cancer screening should not occur without an informed decision-making process.

Men at average risk should receive this information beginning at age 50.

Men in higher-risk groups should receive this information before age 50.

Men should either receive this information directly from their health care providers or be referred to reliable and culturally appropriate sources.

Patient decision aids are helpful in preparing men to make a decision whether to be tested, and the use of such aids is encouraged.

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NEW PROSTATE CANCER INFO-LINK: The latest data from the American Cancer Society suggest that there will be an increase in both prostate cancer diagnoses and prostate cancer deaths in the US in 2010 compared to 2009, but whether this is really of any statistical significance is probably open to question. READ MORE>

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NEW PROSTATE CANCER INFOLINK: It is time for us to take a step back and look at the whole issue of cancer screening with unblinkered eyes, writes Mike Scott of the American Cancer Society’s announcement it will review its policy on cancer screening. READ MORE>

The “New” Prostate Cancer InfoLink expects to receive a lot of “flak” about this particular commentary, but we are adamant about the need for a whole new attitude to cancer screening — an attitude that is based fundamentally on the very best interests of the patient with clinically significant cancer that needs to be found and on the very best interests of consumers in whom it may well be possible to identify cancer cells but who need to know that this form of cancer is of little clinical relevance to their lives.

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NEW YORK TIMES: The American Cancer Society, which has long been a staunch defender of most cancer screening, is now saying that the benefits of detecting many cancers, especially breast and prostate, have been overstated. READ MORE>

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PROSTATE CANCER INFOLINK: Rather than having to ask for a prostate cancer test, men should be offered it but have the right to “opt out”. READ MORE>

That’s the novel view put forward by top US prostate cancer website New Prostate Cancer Infolink, whose administrator, Mike Scott, writes:

The way we see this is that men should have an “opt out” clause that allows them not to get tested for prostate cancer risk.

This is a very American option. One can argue over whether it is right or wrong, but it clearly leaves the decision in the hands of the individual.

His latest blog looks at the somewhat ambivalent views of the American Cancer Society:

It would…be helpful, if the ACS’s chief medical officer would be so kind as to articulate the ACS’s official position with clarity, as opposed to his tendency to articulate his personal opinion about “screening” (ie, mass, population-based testing of everyone), so that the average man in the street was getting a clear message about what the ACS actually does recommend.

Scott’s view is:

…the following people should absolutely be getting PSA tests and physical exams as a means of assessing their risk for clinically significant prostate cancer starting somewhere between 40 and 50 years of age depending on their risk factors:

  • Any man with a family history of prostate cancer
  • Any man with an ethnic risk for prostate cancer (specifically including African Americans)
  • Any man who requests such tests
  • Any man who asks his physician to decide whether he should get such tests for him

In addition:

  • Every man should be having a conversation with his doctor to discuss the relative risks and benefits of testing to detect possible risk for prostate cancer.

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WHYY PUBLIC BROADCASTER: Men as young as 35 are being offered free screenings for prostate cancer at a Philadelphia cancer centre, but the American Cancer Society doesn’t think that’s a good idea. HEAR MORE>

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