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NY Daily News prostate screening promotion conflicts with medical evidence

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The Daily News boasts that today it “begins its ninth year of free prostate screenings at 37 hospitals, medical facilities, recreation centers, churches and office locations across the metro New York area.”

The paper states that “Men age 40 and older and those with a family history of prostate cancer are offered the screenings.”

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.

The paper reports that in the last 8 years, almost 140,000 men have been screened through the newspaper’s efforts.

They report that 7% “were urged to follow up with a visit to their physician or hospital.”

That’s almost 10,000 men.

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.”

You do the math: how many of the 10,000 men the Daily News urged to have followup fell into these categories?

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.”

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Comments

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Michael Kirsch, M.D

July 27, 2009 at 8:22 am

I think that prostate cancer screening is a scam. (See link for a a spirited physician rant.) How can we endorse a process that harms scores of men for an occasional salvage? The medical profession is way behind the evidence here.