Cancer Screening: Me Vs. the Big Picture
The United States Preventive Services Task Force (USPSTF) last week handed down the startling recommendation that men over 75 should not be routinely screened for prostate cancer, and that younger men should weigh their screening options with a physician. That news came shortly after the release of a new study suggesting that teaching women to perform breast self-exams is not worthwhile in the grand scheme of things.
We don't much like the sounds of that, do we?
How can it be bad to use these tools to look for cancers that might otherwise go undetected -- and untreated -- until it's too late? Don't we all know of a man who is still alive because he took a PSA (prostate-specific antigen) test that found his prostate cancer before it killed him, or a woman who felt a lump in her own breast and had it removed, perhaps just in the nick of time?
The tough answer is that, while we make judgments for ourselves about the value of these screening devices based on our own or our acquaintances' experiences, those whose job it is to decide what the medical community should endorse look at the bigger picture.
According to Michael LeFevre, a family physician practicing in Columbia, Missouri and a member of the USPSTF, when it comes to looking for asymptomatic disease of any kind, whether it's high blood pressure or breast cancer, the benefits of screening have to be weighed against the risks. Organizations such as the Task Force review the best available scientific evidence and ask whether screening does more harm than good.
With PSA screening and breast self-exams, that "harm" can include biopsies that ultimately are deemed to be unnecessary, psychological distress, and, in the case of slow-growing prostate cancers in older men who are likely to die of something else before their prostate cancer kills them, treatments that do more damage (including causing impotence) than the cancer itself.
Sometimes, as with high blood pressure, the value of finding and treating the disease is found to outweigh the potential harm (in this case, using medications that can cause unpleasant side effects to treat someone who might not be headed for a heart attack or stroke), LeFevre notes. While there's no way of knowing which people with high blood pressure will end up having heart attacks, science shows that, across the board, it's clearly worth identifying people with the condition and getting them treated.
With older men's prostate cancer and women's breast cancer, though, the link between screening for disease and positive outcomes isn't so clear. Hence the new USPSTF recommendation. The USPSTF hasn't revised its guideline regarding breast self-exam since the new study was published; as it stands, the Task Force says there's not enough evidence to recommend for or against women's learning or performing the technique.
I understand all that -- in theory.
But I intend to keep checking my own breasts. How about you?
Jennifer LaRue Huget
August 11, 2008; 7:00 AM ET
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