The Controversy about Breast and Prostate Screening
Rethinking Screening for Breast Cancer and Prostate Cancer appeared in the Journal of the American Medical Association
Laura Esserman, MD, MBA; Yiwey Shieh, AB; Ian Thompson, MD JAMA. 2009;302(15):1685-1692.
"After 20 years of screening for breast and prostate cancer, several observations can be made. First, the incidence of these cancers increased after the introduction of screening but has never returned to prescreening levels. Second, the increase in the relative fraction of early stage cancers has increased. Third, the incidence of regional cancers has not decreased at a commensurate rate. One possible explanation is that screening may be increasing the burden of low-risk cancers without significantly reducing the burden of more aggressively growing cancers and therefore not resulting in the anticipated reduction in cancer mortality. To reduce morbidity and mortality from prostate cancer and breast cancer, new approaches for screening, early detection, and prevention for both diseases should be considered."
Although seniorwomen.com not able to run the JAMA article, we are able to run the audio of the NPR program for KQED radio, recorded Oct. 22:
Early Cancer Screening
A new study published in the Journal of the American Medical Association finds that aggressive early screening for breast cancer and prostate cancer may do more harm than good. We discusses whether recommendations for healthy people to get screened should be changed.
Host: Michael Krasny
Guests:
George Sledge, professor of oncology and co-director of the breast cancer program at Indiana University
J. Leonard Lichtenfeld, deputy chief medical officer for the American Cancer Society
Laura Esserman, director of the Breast Care Center at UCSF and lead author of the new study
and in mp3 form: 2009-10-22a-forum.mp3 http://kqed02.streamguys.us/anon.kqed/radio/forum/2009/10/2009-10-22a-forum.mp3
For a professional view of the study, Medpage offers: Analysis Questions Breast and Prostate Cancer Screening
"Two decades after the explosion in cancer screening fueled by reimbursement for mammography and prostate specific antigen (PSA) testing, a new analysis suggests that it is time to rethink the push for early detection of these two cancers."
"There is no argument that more cancers are being detected and at a much earlier stage, but that increase has not resulted in a decrease in metastatic disease, according to Laura Esserman, MD, MBA, of the University of California, San Francisco, and colleagues, who made their case in a special communication published in the Oct. 21 issue of the Journal of the American Medical Association."
"In broad strokes they painted a picture of increased detection and costly treatment of cancers that pose minimal risk, without making a dent in killer cancers."
"The researchers touched a nerve with the commentary, and the American Cancer Society has already gone on record saying that it is reconsidering its position on the risks and benefits of breast and prostate cancer screening."
We did come across a MedPage blog critical about a well-known cancer treatment clinic in reference to prostate screenings:
By: Gary Schwitzer | October 16, 2009
"The Roswell Park Cancer Institute in Buffalo has a reputation as one of the finest cancer care facilities in the country."
"But their promotion of prostate cancer screening doesn't match that reputation."
"They've created a Prostate Club For Men."
"On their website, they trot out tired old lines that fail to give the whole story about prostate cancer screening:"
"When it comes to prostate cancer, early detection saves lives. In fact, around 90% of prostate cancers found at an early stage are cured. Men - and the women who love them - need to be proactive in understanding the risk factors and how to 'aim for a cure' through early detection."
"That's what the Prostate Club is all about. As a Club member, you will be making a commitment to discuss screening with your doctor, and, if deemed appropriate for you, have both a PSA test and digital rectal exam (DRE). It's quick and simple, and it could save your life."
"There should be nothing "quick and simple" about the decision to pursue prostate cancer screening."
The rest of the blog post is continued at the link above.
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