In the face of accumulating evidence and a U.S. Preventive Services Task Force finding that PSA screening for prostate cancer does more harm than good, the most frequent response I hear from physicians who continue to defend the test is that PSA is all we have, and that until a better test is developed, it would be “unethical” to not offer men some way to detect prostate cancer at an asymptomatic stage. (However, these physicians for the most part don’t question the ethics of not offering women screening for ovarian cancer, which a recent randomized trial concluded provides no mortality benefit but causes considerable harms from diagnosis and treatment.)
I’m currently reading historian Stephen Ambrose’s dual biography of Oglala Sioux leader Crazy Horse and Civil War cavalry general George Armstrong Custer, whose troops were routed by the Sioux at the famous Battle of Little Bighorn in 1876. One premise of the book is that the same aggressive instincts that served Custer so well during the Civil War Read more »
Cancer. Just the word is scary. Actually, that’s the problem. Once you say that word, the average American will do anything — ANYTHING! — to just get it out of my body!!! Whether or not they have it, whatever the actual numerical chances of their ever developing it, no chance for detecting or treating it should ever be neglected. EVER! Ask any Med-mal lawyer. Better, ask any twelve average people off the street (i.e., the ones who are going to wind up on a jury). “The doctor didn’t do every possible test/procedure, and now the patient has CANCER? String him up!”
Hence we have the new guidelines for PSA testing. (Given that many patients with prostate cancer have normal PSAs and lots of patients with high PSAs don’t have prostate cancer, it doesn’t seem semantically correct to call it “prostate cancer screening”.) Surprise! Turns out that not only does PSA testing not save lives, but that urologists don’t really care. Certainly not enough to stop recommending PSAs to just about everyone they can get their hands on.
Nor do breast surgeons have any intention of modifying their recommendations, not only in light of new understandings of the limitations of mammography, but even as Read more »
If you want to create an outcry of indignation, just inform people that certain screening tests are of no value and do not increase time on this earth. People love the idea that if they do all the right things and get all the medical tests at the right time, they can prevent disease ( ….uh…no, tests don’t prevent anything) or catch cancer early and cure it.
The furor over the lack of benefit for men of the screening Prostate Specific Antigen test (PSA) is still being heard. It seems everyone knows someone who was “saved” by getting a PSA and don’t try to tell me there is evidence to suggest otherwise, dammit!
There is a new report in the Journal of the American Medical Association (JAMA) that Read more »
One wonders how many men have their blood tested for PSA levels looking for prostate cancer without being asked if that’s what they really wanted.
The Foundation for Informed Medical Decision Making (which supports my web publishing efforts) has now posted on its YouTube page a video clip with a man who has some regrets about his prostate cancer screening and treatment experience. It’s the same man featured in the New York Times Sunday magazine piece, “Can Cancer Ever Be Ignored?”
Relevant excerpt from the NYT piece:
“Tim Glynn, a self-described country lawyer from Setauket, N.Y., was 47 in 1997 when he went to his primary-care doctor, troubled by a vague feeling of being down. After his physical exam, Glynn was sent to have his blood drawn. Along with thyroid and cholesterol levels, the doctor ordered a P.S.A. test. Read more »
Some breast cancer voices raise questions about simply raising “awareness” about breast cancer in October.
Some of them believe that raising awareness about screening, for example, should not be the only message or even the main message of the month.
Katherine O’Brien, who has metastatic breast cancer (MBC), and who publishes the ihatebreastcancer blog refers to being caught in “October’s pink undertow.”
O’Brien says that people like her with MBC have different concerns from those with early stage cancer. She wrote to me: “The day is not about general cancer awareness; it’s about acknowledging the distinct needs of people who have the advanced, incurable form of breast cancer.
She quotes Ellen Moskowitz, past president of the Metastatic Breast Cancer Network (MBCN): Read more »
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