What DOES the American Cancer Society recommend about screening?

The messages coming from the American Cancer Society (ACS) and from its chief medical officer about “screening” for prostate cancer may be confusing for many — not only “the man in the street” but also the primary care community. We thought we would try to clarify the situation.

The following is the EXACT wording of the ACS’s recommended prostate cancer screening guideance “for those people at average risk for cancer (unless otherwise specified) and without any specific symptoms” (click here for source information on the ACS web site):

The American Cancer Society (ACS) does not support routine testing for prostate cancer at this time. ACS does believe that health care professionals should discuss the potential benefits and limitations of prostate cancer early detection testing with men before any testing begins. This discussion should include an offer for testing with the prostate-specific antigen (PSA) blood test and digital rectal exam (DRE) yearly, beginning at age 50, to men who are at average risk of prostate cancer and have at least a 10-year life expectancy. Following this discussion, those men who favor testing should be tested. Men should actively take part in this decision by learning about prostate cancer and the pros and cons of early detection and treatment of prostate cancer.

This discussion should take place starting at age 45 for men at high risk of developing prostate cancer. This includes African American men and men who have a first-degree relative (father, brother, or son) diagnosed with prostate cancer at an early age (younger than age 65).

This discussion should take place at age 40 for men at even higher risk (those with several first-degree relatives who had prostate cancer at an early age).

If, after this discussion, a man asks his health care professional to make the decision for him, he should be tested (unless there is a specific reason not to test).

We have pointed out regularly that there is a BIG difference between mass, population-based “screening” (of everyone) at a particular age, and the clinical decision (for all sorts of possible reasons) to test specific individuals for prostate cancer risk at specific times.

The “New” Prostate Cancer InfoLink’s interpretation of the ACS guidelines would be that they also endorse this viewpoint. What it comes down to is that the following people should absolutely be getting PSA tests and physical exams as a means of assessing their risk for clinically significant prostate cancer starting somewhere between 40 and 50 years of age depending on their risk factors:

  • Any man with a family history of prostate cancer
  • Any man with an ethnic risk for prostate cancer (specifically including African Americans)
  • Any man who requests such tests
  • Any man who asks his physician to decide whether he should get such tests for him

In addition:

  • Every man should be having a conversation with his doctor to discuss the relative risks and benefits of testing to detect possible risk for prostate cancer

The way we see this is that men should have an “opt out” clause that allows them not to get tested for prostate cancer risk. This is a very American option. One can argue over whether it is right or wrong, but it clearly leaves the decision in the hands of the individual.

It would, however, be helpful, if the ACS’s chief medical offer would be so kind as to articulate the ACS’s official position with clarity as opposed to his tendency to articulate his personal opinion about “screening” (i.e., mass, population-based testing of everyone), so that the average man in the street was getting a clear message about what the ACS actually does recommend.

3 Responses

  1. I wonder. What does the ACS actually do for cancer patients?

  2. In Virginia they are doing less and less for prostate cancer. In the past they had two men’s health forums for the under-served community. They have canceled one and have removed at least part of the prostate cancer component for one of them. They have cut-backs in staff who do outreach to the community. In discussions with other state coalitions they have been experiencing similar pull-backs for prostate cancer. They do have the Man to Man programs and several programs for breast cancer, including a patient navigator program. They fund research and I know they have worked with internal medicine specialists to develop a program to educate African American men about prostate cancer.

    80% of their money is spent on colon, breast and lung cancer issues. Those are their priorities. They are also focused on pain and nutrition.

  3. I have had cancer for nearly 3 years and I have yet to see any “where the rubber meets the road” participation from them here in Nevada.

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