May 29, 2012
Thoughtful week-after analysis of PSA screening recommendations
Too often, the demands of same-day journalism dictate that today’s announcement is reported and then journalists move on to the next day’s announcement and the next day’s journal study without a chance to step back and reflect.
Appropriately, some journalists are taking/finding the time to reflect on last week’s prostate cancer screening recommendations from the US Preventive Services Task Force.
- “People are taking a closer look not just at cancer screenings, but at all medical tests and procedures, says Steven Woloshin, co-director of the Center for Medicine and the Media at the Dartmouth Institute for Health Policy and Clinical Practice. Concern about “overtesting” and “overtreating” patients is growing because of a rising recognition that these interventions often have risks and serious side effects.”There is something going on, not just in cancer,” Woloshin says. “There is some sort of shift, and it’s encouraging. It feels like this is the beginning of a sea change in attitudes towards testing, treating and overdiagnosis.”
- She also quotes Dartmouth’s Dr. Gil Welch: “It’s hard to make a well person better, but it isn’t hard to make them worse.”
- The Washington Post’s Brian Vastag has a very thoughtful piece in which he writes:
- “THE PSA TESTS SAVED MY LIFE!!!” one man wrote in an e-mail to The Post, calling the government task force a “death panel.”He was expressing a cancer narrative that runs strong in our culture. It goes like this: I got a cancer test. It showed a suspicious result. A biopsy (which snips out a bit of tissue) then revealed that I had cancer. I chose treatment. Surgery, radiation or chemotherapy got rid of the cancer. I’m cured now.The test saved my life.Well, maybe.
With prostate cancer, there’s a problem with that story: There’s often no way to know if a particular case would have been fatal if left untreated. That is, it’s impossible to know if the treatment really cured you — or if you would have lived a long life without it.
It’s an unsatisfying — and confusing — reality of prostate cancer. ……
No one says: I got a PSA test. It was high, so I got a biopsy. The biopsy caused pain for weeks and made me bleed. But I didn’t have cancer. Good thing I got that test.
No one says: I got a PSA test. It was high, so I got a biopsy that showed I had a small, low-risk tumor. I got surgery. Now I wear a diaper and can’t make love to my wife. And I wonder if I really needed to go through all that.
The practice feeds a story we all want to tell ourselves: I did something. I was cured.