Posts Tagged ‘mammograms’

BRADENTONHERALD.COM: As the baby boomers prepare to join the 65-plus set over the next decade, medical experts are weighing the benefits and costs of cancer screenings for seniors. Mammograms for women in their 80s, colonoscopies for men and women 75 and older, and PSA (prostate specific antigen) blood tests for older men are especially controversial. READ MORE>

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JULY 3: PROSTABLOG NZ: In what seems to be exquisite timing, NZ’s parliamentary select committee on health is starting an inquiry into prostate cancer screening – just as some of the best recent analysis of screening emerges in the US.

The latest informative discussion comes from Mike Scott at the New Prostate Cancer Infolink website, one of the leading American aggregators of up-to-date information.

As global debate hots up following recent publication in a medical journal called CA: A Cancer Journal for Clinicians of an article about screening and an accompanying editorial, Scott today makes some interesting points:

  • Media reporting of this latest look at the two large randomised studies is well wide of the mark.
  • What the article actually makes clear is we just do not know how best to use the tools currently available to test an individual man so as to ascertain with accuracy his real risk for clinically significant prostate cancer.
  • So — surprise, surprise — we need better tests, as America’s Prostate Cancer Organizations have already clearly stated.
  • A critical element, covered in the article, is the importance of taking account of the patient’s age, life expectancy, family history, race/ethnicity, and other personal health factors in making the decision whether testing for prostate cancer is appropriate or not.
  • The article does not discuss, at all, the potential merits of  “baseline” PSA testing (at any specific age).
  • The journal’s accompanying editorial uses some “loaded” language in making the correct recommendation that regular, mass, population-based screening is not currently justified based on the available evidence. That “loaded” language is centered around the use of the terms “over-diagnosis” and “over-treatment.”
  • There is excellent evidence today that “mass, population-based screening” using mammograms to look for breast cancer is no more justified that prostate cancer screening, on any good statistical basis. Some 2,970 women must be screened once to find 27 cancers and save one life (in women aged between 40 and 65 years of age). The editorial repeats the finding of the European trial that it would be necessary to screen 1,410 men and find an additional 48 cancers to prevent one prostate cancer-specific death.
  • There are simple answers to the issue of “over-reaction” (to screening findings from doctors and patients), and they start with greater honesty — among the clinical community and among the survivor community — about what we really do and don’t know.
  • Over the past 30 years, prostate cancer deaths have dropped 20% in the US, but…”We still can’t tell [which patients are at real risk] beforehand, and so fear and  ‘standard practice’  tell us that we should proceed with treatment ‘to be on the safe side’. We need to do better. And it doesn’t help to demonize the problem with terms like ‘over-diagnosis’ and ‘over-treatment’.”
  • In all truth, we do not have good enough information to allow us to know the best thing to do for the vast majority of men who are at only a statistical (as opposed to a clinically evident) risk for prostate cancer.

It’s to be hoped someone draws the Health Select Committee‘s attention to this latest development in the debate, which has rumbled along since late March, when the results of the long-awaited studies were published in the New England Journal of Medicine – and failed to resolve anything.

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MAY 14: READERS DIGEST:  The following is the full text of an angry letter from the American Cancer Society sent to Reader’s Digest following an article it ran on prostate cancer screening in April. READ MORE>

Your article, “Cancer Screening: Doing More Harm than Good” (April 2009), lacked a sense of balance and honest commentary that would help inform your readers rather than frighten them. You’ve left your readers without a truly informed viewpoint on the issues of cancer screening, the science and the facts.

To say that those of us engaged daily in the fight against cancer are not aware that we will pick up cancers that would never cause a problem, or that there may be harms from the biopsies and treatment for cancer is a profound misrepresentation of what we know and what we recommend for cancer screening. We think about those issues every day. We talk about them, we argue about them, we write about them.

We believe that the scientific evidence shows that mammograms save lives and that colorectal cancer screening saves lives, and could save a lot more if we had more people screened. We believe the Pap test has been incredibly successful in reducing deaths from cervical cancer in the United States and other developed countries.

The fact is we don’t know who is going to get cancer and who is not. We don’t know which cancers are potentially lethal and which are not. We don’t know which cancers are going to be impacted in a good way by being found early and which are not. The reason we accept the risks of over diagnosis and treatment is that we believe the evidence shows that these screening procedures—when applied to large numbers of men and women—do save lives.

But, we are not blind to the questions that must be raised and must be answered before a population-based recommendation is made. When the American Cancer Society makes recommendations for the prevention and early detection of cancer, we have to consider what is the best course of action that applies to hundreds of millions of people.

We recognize very clearly that when we don’t have the evidence that screening works, we must say so. Such is the case with prostate cancer screening, where we say routine screening is not warranted, and clearly advocate that men have a discussion with their doctors or other health care professionals to discuss the pros and cons of prostate cancer screening before deciding whether to get tested.

If I seem a bit angry and perturbed about this debate, it’s because I have been around long enough to remember what life was like in the 1960’s and 1970’s before we had any of this evidence about screening. I remember what we meant by “early” breast cancer in the days before effective mammograms were available.

I remember women walking into the emergency department with towels wrapped around their breasts, bleeding from a mass or having discharge from the nipple.  There was no screening, and living five years for many of these women was considered a miracle. I have no desire to go back to those days.

To suggest that we have hurt more than we have helped through screening for those cancers where the evidence shows otherwise is, in my personal opinion, ludicrous.

I would suggest that cancer screening—as imperfect as it may be—is not the place to start cutting back on your health care. But until that time of perfection comes, please do not provide your readers with scare stories or horror stories that strike fear. Inform, educate, and guide them. But do not scare them. That is a terrible disservice, in my opinion.

Len Lichtenfeld, M.D., M.A.C.P.
Deputy Chief Medical Officer
American Cancer Society

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