CNN Screening Advice for Men

In early February, on CNN’s American Morning program, CNN medical correspondent Dr. Sanjay Gupta discussed “tips for men” about what kind of medical tests they should have in their 30s, 40s and 50s. (Transcript)

Gupta and guest, Dr. Christopher Kelly of NYU School of Medicine, then listed a series of tests they recommend for men in their 30s, including a baseline electrocardiogram (ECG). But their advice clashes with that of the U.S. Preventive Services Task Force, a group of medical experts convened by the federal government to conduct rigorous, impartial assessments of scientific evidence and develops recommendations for clinical preventive services.

Routine ECGs are not recommended for men in their 30s who don’t have risk factors. Their value in middle-aged men with risk factors is unclear.

The task force lists important weaknesses in the idea of using routine ECGs, and reminds consumers of “the lack of evidence that earlier detection leads to better outcomes.” The task force advises that “routine screening with ECG should be avoided in populations where the prevalence of coronary artery disease is low, including most adults under 40. …The inconvenience, expense, and potential risks of routine screening might be justified if it significantly reduced the incidence of MI and sudden cardiac death, but such evidence is not yet available.”

Gupta later stated that “men should visit their doctors annually,” a controversial recommendation at best.

His guest, Dr. Kelly, then said that men in their 50s “should also be aware that they need prostate cancer screening.” He said they need it. But the U.S. Preventive Services Task Force (USPSTF) says “there is not enough evidence to tell whether such screening is effective or not.”

“The USPSTF found good evidence that PSA screening can detect early-stage prostate cancer but mixed and inconclusive evidence that early detection improves health outcomes. Screening is associated with important harms, including frequent false-positive results and unnecessary anxiety, biopsies, and potential complications of treatment of some cancers that may never have affected a patient’s health. The USPSTF concludes that evidence is insufficient to determine whether the benefits outweigh the harms for a screened population.”

Gupta concluded by saying that for men like the one he profiled at the beginning of the story, “early tests and early detection could be a lifesaver.” Yes, it is possible that early detection can be a lifesaver. But as you’ve just seen, enthusiasm for early tests is often not supported by evidence. There can be harms from doing screening tests in people without symptoms when the evidence doesn’t support such screening.

We hope CNN and other journalists can learn from this review.