Health News Review

Headlines every day in the New York Daily News are luring men in as part of a mass prostate cancer screening campaign which the American Cancer Society not only does not endorse – its chief medical officer recommends against. Yet the paper brags that it is beginning its second decade of this non-evidence-based campaign. Sample headlines:

• Doctors urge New York men to take advantage of free, city-wide PSA testing

• What you don’t know can kill you. Get a FREE prostate cancer test. It can save your life

• Bring dad in for FREE prostate cancer test across the city on Father’s Day

and

• Don’t skip the PSA test! My prostate cancer is treatable because simple test caught it early (written by a Daily News staffer).

Meantime, as I wrote one year ago when the Daily News promoted this campaign:

Either the paper doesn’t realize or doesn’t care that:

* The American Cancer Society does not support routine testing for prostate cancer at this time and specifically recommends AGAINST such mass screenings.

* The US Preventive Services Task Force and the American Academy of Family Physicians state that “Current evidence is insufficient to assess the balance of benefits and harms of screening for prostate cancer in men younger than age 75 years.”

* No major group – except urologists – recommends starting screening as early as this newspaper does – starting at age 40. And that urology group’s thinking is the source of major controversy.

That’s a huge public responsibility for a newspaper to take on – especially when it conflicts with medical evidence.

Before being screened, what did the newspaper inform men about the tradeoff of harms and benefits? On the American Cancer Society website, its president, Dr. Otis Brawley says:

“There are some proven harms associated with screening. Screening, for example, leads to unnecessary treatment in some men who are diagnosed with localized disease.

It is difficult to comprehend, but there are prostate cancers that are confined to the prostate and never destined to metastasize (spread to other parts of the body). Screening diagnoses a large number of men who would never be bothered by the disease. In one clinical trial, more than 12% of average risk men were diagnosed through screening over 7 years. This group of men is estimated to have a lifetime risk of death of less than 4%. This study suggests that 2 out every 3 men in this study did not need to be diagnosed nor treated. While this study suggests that the proportion of men in the overall population who are diagnosed with cancers that do not need therapy is as high as 67% of men with localized disease, others estimate it to be as low as 30%. We have very poor ways of predicting who needs treatment because their prostate cancer might kill them, and who does not need therapy because their tumor is of no threat to them.”

It’s not just a simple blood test, as it is so often promoted. That’s why Dr. Brawley says:

“Many health care provider organizations and many well-meaning community groups encourage prostate cancer screening and offer mass screening at health fairs and other activities. The American Cancer Society is concerned that so many do not understand that the benefits of screening are still undetermined. The ACS recommends against such mass screening activities because one cannot be assured that the patient has the opportunity to hear a balanced explanation of screening in an environment in which he can feel comfortable to ask questions and make an informed decision.”

Even more to the point of the newspaper’s promotion and advertising of this mass screening, Brawley wrote in an editorial in the Journal of the National Cancer Institute:

“I heard a radio commercial that brings perspective to the issue. A local celebrity was promoting prostate cancer awareness. He said, “Prostate cancer is 100% curable when caught early.” He encouraged all men to get screened and announced that a van was touring the area offering screening in supermarket parking lots. This was a community service project sponsored by the radio station, the supermarket chain, and a radiation oncology practice.

A commercial like this plays to our fears and prejudices. …

Prostate cancer screening has resulted in substantial overdiagnosis and in unnecessary treatment. It may have saved relatively few lives. … The benefits of prostate cancer screening are still open to question. This means that informed or shared decision making should be done using the data now available before screening is performed. Some of the confusion of prostate cancer screening can be avoided if we all clearly label what we know, as what we know; what we do not know, as what we do not know; and what we believe, as what we believe. Of course, one must not confuse what is believed with what is known to do this.”

Comments

e-Patient Dave posted on June 21, 2010 at 10:06 am

So is this just simple sensationalistic pandering by idiots who don’t care that they’re giving unhealthy advice?
Is it essentially “medical junk food,” as in “we’ll sell anything people will buy”?

Gary Schwitzer posted on June 21, 2010 at 10:27 am

Dave,
I don’t believe it’s malicious on the paper’s part. To the contrary, they probably think this is a no-harm, no-brainer, public service campaign.
But as Dr. Brawley points out so eloquently, it’s NOT. There are harms that can occur from such screening campaigns.
And that message – that screening can cause harm – is one that many news organizations across the US just don’t seem to grasp.
So a news organization – that is supposed to be grounded in facts and evidence – is blindly ignoring the best medical evidence and crossing the line into advocacy of a campaign that is not supported by even the American Cancer Society.
It is time for such news organizations – and their readers – and consumers everywhere to wise up to the evidence (a line you used in a blog post recently!).

robert abelson posted on June 22, 2010 at 2:46 pm

I have met hundreds of men diagnosed with prostate cancer by volunteering at prostate clinics in Toronto Ontario. Every man that I ask agrees that the PSA test was the calalyst to further investigation of the disease.
I will probably agree that all men who are sent for a biopsy because of elevated PSA results should not be treated as aggressively as they are, but men have to educated themselves a whole lot more on the topic before they sign the consent form for a procedure.
Most doctors I speak to suggest that men seek a second and sometimes a third opinion before agreeing to any procedure. As well, find support groups where you can exchange information with men who have been through treatments to help one decide which treatment is the best for them, and I include Active Surveillance as a treatment.
Perhaps by learning more, getting second and third opinions, men will be able to make more informed decisions, but DO NOT stop the PSA testing, because, not all men diagnosed are Gleason 6 or less, many are Gleason 7 and higher, and treatment is a way to extend ones life, in a manner that in most cases is not too lifestyle altering

Gary Schwitzer posted on June 22, 2010 at 3:21 pm

Robert,
I posted your comment even though it didn’t comment on the journalism questions which were at the core of my original post.
And on the medical questions, I would urge any man considering such “walk-up” mass screenings to read Dr. Brawley’s writings on this issue first. I think he knows a few things about prostate cancer.