Screening: the discussion is getting broader

Although the pros and cons of mass screening for prostate cancer have been the focus of extensive discussion on this site and elsewhere in recent weeks, some readers may be aware that this is just a part of a broader discussion of the appropriateness of mass screening for a variety of chronic diseases. An editorial in The Lancet this week tackles the broad issues.

Under the heading “The trouble with screening,” The Lancet focuses in on several key issues that are relevant to the broad use of screening for a variety of non-infectious disorders:

  • Does the information provided about screening for a specific disorder really tell the truth?
  • Does a specific screening initiative really provide a public health benefit, which would need to be measurable not necessarily in  terms just of “deaths delayed” but perhaps more appropriately in terms of “disease burden” by reducing the prevalence of the condition being screened for?
  • Is there an economic incentive to promote screening for the providers of the service, and does that affect the accuracy of the information they provide to patients?
  • Should the development of publicly available information about screening for a specific disorder be carried out only by people independent of the providers of the specific screening services available?

In the concluding paragraph of its editorial, The Lancet writes:

Around the world, different countries have screening programmes for many diseases, including cervical, breast, prostate, and colorectal cancers, and cardiovascular diseases. Each one is surrounded by controversy, not only because the data on benefits and harms are not straightforward, but also because of the vested interests … that make screening into a business. The public is left totally confused, and usually at the mercy of screening providers. Before becoming a patient, a healthy individual deserves fully informed consent, with information provided at the individual and population level.

Although this paragraph is the only mention of prostate cancer in The Lancet editorial, the editors do seem to have captured some of the critical issues that underlie the debate about prostate cancer screening in the USA and around the world.

Having said that, The “New” Prostate Cancer InfoLink continues to stand by the following key points made in the Joint Statement issued in late March by almost all of the major prostate cancer patient advocacy, education, and support organizations:

  • Every man, regardless of his age, has the right to know whether he is at risk from prostate cancer, a disease that still kills over 28,600 American men every year, and many more around the world. We encourage all men to be proactive, and to seek out information and support in regard to their health.
  • We shall continue to encourage every man to discuss his individual risk for prostate cancer with his doctors, and to request the appropriate use of PSA and DRE tests until better options are available. Further clinical action based on results of these tests is also a matter for serious discussion between each patient and his physicians.
  • We call upon the medical research community to place greater emphasis on the development of new clinical tests that can differentiate between those men at greatest need for aggressive prostate cancer treatment and those with indolent forms of the disease who can be well managed without invasive treatment.

The full text of the editorial in The Lancet is available to any reader who provides minimal registration information on The Lancet‘s web site.

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