Tag Archives: cancer screening

Cancer society’s messages on screening conflict

The New York Times‘ Gina Kolata reports that the American Cancer Society, a longtime defender of early detection and cancer screening, is planning to release an online message next year “to emphasize that screening for breast and prostate cancer and certain other cancers can come with a real risk of overtreating many small cancers while missing cancers that are deadly.”

MRI
MRI entrance, photo by Scott & White Healthcare via Flickr.

“We don’t want people to panic,” said Dr. Otis Brawley, chief medical officer of the cancer society. “But I’m admitting that American medicine has overpromised when it comes to screening. The advantages to screening have been exaggerated.”

The ACS’ change of heart on breast and prostate screening was inspired, in part, by a recent analysis published in JAMA.

In it, researchers report a 40 percent increase in breast cancer diagnoses and a near doubling of early stage cancers, but just a 10 percent decline in cancers that have spread beyond the breast to the lymph nodes or elsewhere in the body. With prostate cancer, the situation is similar, the researchers report.

In an interesting side note, Kolata includes a quote from Colin Begg, a biostatistician at Memorial Sloan-Kettering Cancer Center in New York, that shows a different perspective on media coverage of the screening debate.

“I am concerned that the complex view of a changing landscape will be distilled by the public into yet another ‘screening does not work’ headline,” Begg said. “The fact that population screening is no panacea does not mean that it is useless,” he added.

Kolata’s story was published on Tuesday. On Wednesday, the ACS released a statement from Brawley in which he says the organization stands by its screening recommendations. In the statement, Brawley says ACS “stands by its recommendation that women age 40 and over should receive annual mammography” and that its recommendation that men consult with their doctors to “make an informed decision about whether or not prostate cancer early detection testing is right for them. ”

The LA Times‘ Booster Shots blog has more, as does NPR’s health blog.

Schwitzer: One-sided push for screening wrong

On his Schwitzer health news blog, University of Minnesota journalism professor, HealthNewsReview.org editor and AHCJ member Gary Schwitzer reminds journalists – in particular, CNN’s Howard Kurtz and Larry King – that even when you’re talking to prostate cancer survivors about screening for the disease, it’s “wrong to use a network television platform to give one-sided advice to an entire population of men without giving balancing information on harms.”

Reminding journalists that PSA screening might not always be a good thing, Schwitzer quotes the U.S. Preventative Services Task Force:

Potential harms from PSA screening include additional medical visits, adverse effects of prostate biopsies, anxiety, and overdiagnosis (the identification of prostate cancer that would never have caused symptoms in the patient’s lifetime, leading to unnecessary treatment and associated adverse effects). Much uncertainty surrounds which cases of prostate cancer require treatment and whether earlier detection leads to improvements in duration or quality of life.

Organization: Teen breast tests wasteful, harmful

Jeff Baillon of KMSP in Minnesota’s Twin Cities reports that the National Breast Cancer Coalition (a nonprofit grassroots advocacy and fundraising organization) opposes Sen. Amy Klobuchar and Rep. Debbie Wasserman Schultz’s proposed education program pushing for breast cancer screening in girls as young as 15.

The coalition’s president called the bill a “waste of taxpayer dollars,” saying that it could actually “harm young women,” Baillon reported.

In the piece, oncologist Barry Kramer, who leads the Office of Disease Prevention at the National Institutes of Health, sayys there is no evidence that early screening is beneficial to young women, and some that it may even harm them through unnecessary biopsies that may then impede detection later in life when the risks are much higher.

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Experts: Benefits of cancer screenings overinflated

In Reader’s Digest, Shannon Brownlee reports that while the American Cancer Society and federal government still push regular cancer screenings, “a growing group of scientific heretics – published in highly respected medical journals, working at some of the most august institutions – strongly believe that it’s time to rethink our whole approach.”

(Some researchers) say that yearly mammograms are not nearly as effective at reducing the risk of dying of breast cancer as most women think, and that mammography leads many women to get unnecessary treatment – especially those diagnosed with DCIS [ductal carcinoma in situ]. The problem is bigger than just mammography: They say the prostate-specific antigen (PSA) test may do men more harm than good if they don’t already have symptoms of prostate cancer. And they have similarly grim things to say about other widely used cancer screening tests.

Experts that Brownlee interviewed say that screening catches tumors that would never cause major problems but not so effective at catching the more deadly, fast-growing kinds of cancer. Only a small percentage of all cancers that occur are fatal, and some cancers disappear on their own, Brownlee reports.

Brownlee also answers reader questions directly and has talked to AHCJ about her book, Overtreated.