More media coverage on prostate cancer screening

An article to be published in the July/August issue of CA: A Cancer Journal for Clinicians, but not yet available on line, as well as the accompanying editorial, is causing a flurry of new, and somewhat misleading, media information about the association between individual testing for risk of prostate cancer and the potential of mass PSA screening to lead to prostate cancer “overdiagnosis.”

According to a report in Bloomberg News, the paper in CA: A Cancer Journal for Clinicians states that “Routine blood tests to screen for prostate cancer are unnecessary, expensive, and lead to the overdiagnosis of cancer and medical complications from treatment.” It supposedly also contains the statement that, “almost half of prostate cancers detected by a blood test in blacks, and more than a quarter in whites, won’t cause symptoms or death and don’t need treatment.”

The authors of the accompanying editorial comment that there “hasn’t been a well-designed clinical trial yet that shows screening reduces death risk,” and states that before the availability of PSA testing, “American men had an 8.7 percent lifetime risk for a diagnosis of prostate cancer, with a 2.5 percent chance of death from the disease.” Supposedly the article also states that, “Two decades later, American men are about twice as likely to be diagnosed, due to widespread testing, and only three percent die of the disease.” Finally, the editorialists also remark that, “For nearly two decades, testing has been based on blind faith in early detection as opposed to being based on evidence of a decrease in mortality as observed in well-designed clinical trials” (according to another article on MedPage Today.

Now some of this information is correct — if it is placed in an appropriate context, and so The “New” Prostate Cancer InfoLink does not intend to comment any further on this article — or the accompanying editorial — until we can read the actual materials in full, and comment with full context.

We will, however, state for the record, that we do not believe this type of media coverage is in anyone’s best interests when the actual material on which the media coverage is based is inaccessible to physicians and their patients.

For instance, an “interim analysis of the European Randomized Study of Screening for Prostate Cancer (ERSPC) revealed a mortality rate ratio 0.80 favoring screening, but a near doubling in incidence.” So, “in the ‘best case scenario,’ as indicated by the ERSPC, the number needed to screen was 1,410, and 48 additional cases of prostate cancer needed to be treated to prevent one prostate cancer death.” Altogether, co-author Otis W. Brawley, MD, of the American Cancer Society, says the “evidence supports a recommendation against mass screening, rather than justifying its current common use in the US.” In fact, the studies indicate that “an average man who gets screened is 48 times more likely to be harmed by screening than he is to be saved by screening at nine years after diagnosis.”

One Response

  1. I think that given ACS’s breast cancer priority, Dr. Brawley should look at:

    Keen JD, Keen JE. What is the point: will screening mammography save my life? in BMC Med Inform Decis Mak. 2009;9:18.

    They report that: “2,970 women must be screened once to save one life.” How is that for equality?

    Guess all is well for the 28,000+ men that bite the bullet from PCa. … Thanks Dr. Brawley!

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