Screen Saver?
For years now, doctors, nurses, health educators, and patients have sung the praises of screening and subsequent early detection, aggressive therapy, and increased longevity for breast and prostate cancers. They may have gotten it all wrong, however! In fact, recent retrospective studies done at the University of California at San Francisco (UCSF) and the University of Texas Health Science Center in San Antonio, and published in the October 21, 2009 issue of the Journal of the American Medical Association (JAMA), have demonstrated the ineffectiveness of 20 years worth of screening for breast and prostate cancers, which currently account for over 25 percent of annual cancer diagnoses in the United States, in significantly reducing the death rates from those maladies. So, perhaps doctors should refrain from teaching their patients how to perform breast self-exams, until their efficacy can be proven. If that were not all, in November 2009, a federally appointed panel of experts, known as the U.S. Preventive Services Task Force, all but panned baseline mammograms at age 40 in women with neither risk factors nor family history of breast cancer. The rationale behind the task force’s pronouncement from on high was an end not justifying a means, with the risks of mammograms before age 50 outweighing the benefits of early detection of breast cancer. New recommendations, that women aged 50-74 years without symptoms or risk factors of breast cancer undergo mammography every other year, instead of annually, have unleashed a wave of accusations, criticisms, finger-pointing, and protests that the federal government is now rationing health care, to the detriment of its citizens. Nonetheless, evidence continues to mount that screenings are neither savers nor saviors, and even the American Cancer Society (ACS), one of the staunchest supporters of cancer testing, has had to reevaluate its position and scale back support of mass breast and prostate cancer screenings.
The change in position of the ACS and other former supporters of early, regular, and frequent screening stems from the increased detection of small, slow-growing breast tumors that may never cause harm, at the expense of aggressive tumors that arise and grow rapidly between screenings. Were that not all, repeated exposures to screening radiation, false-positive diagnoses of breast cancer, and overtreatment and extensive procedures for slow-growing tumors that may never cause problems place women and their families in the precarious positions of being “damned if they do” and “damned if they don’t.” On the prostate side, controversy is no less evident, with neither the ACS nor the Preventive Services Task Force recommending or justifying routine screening for prostate cancer via prostate-specific antigen (PSA) blood tests, in the face of the most common cancer in men presiding over an increased mortality risk of only 3 percent. So, satisfactory answers are not immediately forthcoming, and each patient must rely on introspection and personal health philosophy to guide judgment on the wisdom and benefits of detecting small, slow-growing, non-aggressive, and/or only remotely lethal tumors, in exchange for peace of mind that may not outweigh the burden of knowledge, the potential complications and drawbacks of overtreatment, and the financial hardships imposed. It makes no sense to inflate unnecessary screenings in these times of shrinking health care dollars.
This medical piece would not be complete, without some final affirmations and a bit of advice to the readers. While regular breast cancer screening is warranted in patients over 50 years of age with no risk factors, it does not mean annual mammograms. Women aged 50-80 with low or average risk may be screened by mammography every other year, with those over 80 perhaps no longer requiring mammograms. Worrisome are the patients who go five or more years without a mammogram, not those screened every one or two years. Self-discovery of a lump or abnormality in a breast, however, no matter how recent the mammogram, mandates immediate visit to a physician.
In the “non-fairer” sex, on the other hand, the jury is still out on routine annual PSA testing to screen for prostate cancer. For every man who avoids prostate cancer, 50 will be treated unnecessarily with subsequent incontinence and impotence resulting, due to a test that fails to distinguish slow-growing cancers that will never cause problems from the aggressive kind.
A screen saver works just fine in the inanimate, but when it comes to the living and breathing, too much of the scientific community’s best of intentions does not always make for a happy ending. In fact, quite the contrary!
ã 2010, Albert M. Balesh, M.D. All rights reserved.
posted by Dr. Al at
4/18/2010 03:19:00 PM
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