Wednesday, October 21, 2009

Are Certain Cancer Screening Benefits Overstated?

The answer may be a qualified yes.
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.

It is quietly working on a message, to put on its Web site early next year, to emphasize that screening for breast and prostate cancer and certain other cancers can come with a real risk of overtreating many small cancers while missing cancers that are deadly.

“We don’t want people to panic,” said Dr. Otis Brawley, chief medical officer of the cancer society. “But I’m admitting that American medicine has overpromised when it comes to screening. The advantages to screening have been exaggerated.”
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Prostate cancer screening has long been problematic. The cancer society, which with more than two million volunteers is one of the nation’s largest voluntary health agencies, does not advocate testing for all men. And many researchers point out that the PSA prostate cancer screening test has not been shown to prevent prostate cancer deaths.

There has been much less public debate about mammograms. Studies from the 1960s to the 1980s found that they reduced the death rate from breast cancer by up to 20 percent.
None of this addresses the fact that screenings are extremely useful for those in high risk groups, such as those women who are on hormone replacement therapy or those people with a family history of cancer.

Screenings are general guidelines and just one tool in improving personal health. In fact, screening for colon cancer and cervical cancers have resulted in significant improvement in detecting cancers at an early stage with a reduction in advanced cases.

What this suggests to me is that PSA screening for prostate cancer and mammograms for breast cancer detection need additional or different tests to better and more effectively screen and catch cancers at early stages. The complexity and multiple causations (particularly breast cancer) of those cancer types make screening alone more problematic. It also means that oncologists need to better tailor treatments to the cancers picked up by various screening methods.

Moreover, a message that suggests that screening isn't effective is going to reduce the number of people who should be getting screening, resulting in more people needlessly suffering from advanced cancers.

The study also seems to indicate that the incidence of cancers may be overstated because some of the cancers that have been detected are ones that will not fatal or are shown to become metastatic (spreading through the body to other organs). Also, it may actually point out that breast cancers are particularly aggressive and may spread faster than the current recommended mammogram cycle (cancer spread invasively between mammograms).

In other words, this study needs further analysis and study to determine just what lessons need to be learned. Media reports that don't reflect and highlight this are going to do a serious disservice to the public.

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