Public perception and [prostate and other] cancer screenings

We aren’t sure exactly what this adds to the recent conversations, but Gallup, the market research firm, has just provided results of a poll that asked 1,102 upstanding American adults for their opinions about cancer screening.

According to this poll:

  • Just over half the repondents were male.
  • 58 percent thought that “standard” cancer screenings (e.g., Pap smears, mammograms, colonoscopies, and PSA tests) were performed often enough.
  • 31 percent thought such “standard” cancer screenings were not done often enough.
  • 7 percent thought such “standard” cancer screenings were done too often.
  • This left 4 percent who had the tranditional “no opinion.”

Reuters quotes Gallup as stating that:

Americans for many years have heard the traditional admonition that ‘early detection’ of cancer is always beneficial for the patient, and the results of the current question suggest that this belief still holds in the minds of most.

More detail about this poll can be found on the Gallup web site. It includes information about people’s opinions based on their age and their educational level.

When one considers how much money we have spent over the past 40 years telling people how important it is to get screened (as opposed to telling them about the risks and the benefits of getting screened), the public perception suggested above is entirely understandable. Whether it is “correct” is an entirely different issue!

9 Responses

  1. When you learn that your PSA is almost 4, you are going to want to know if it is increasing and how fast. Once it is over 4, you are going to a urologist for expert evaluation and prognosis. I don’t care what government organizations say. I don’t believe their motives are in the best interests of the population. Doctors should make that evaluation on an individual basis. I’m there. I wouldn’t have done it any different.

  2. Take one good look at our government and our leaders, then take a good look at today’s greedy CEOs and ask yourselves, “Do I REALLY trust their motives”?

    Now that we have settled that questions with a resounding NO!

    My PSA had started rising when I was about 52. It rose each year slightly, still under the magic number of 4.0, until I was 59, when it crossed the line to 4.1. It continued to rise to 6.1 ng/ml when I was 62. A free PSA test resulted in a reading of 15%, at which time I had sample biopsies taken which confirmed cancer in the right side of the gland, all internal to the prostate. I elected for a RP in 2003. So don’t let anyone tell you that annual PSAs are not needed for all men, I had no family history of this type cancer. If you want to roll the dice … be very careful.

  3. Dear Richard:

    There is a serious problem with your analysis, which is that we have known for at least 8 years that the idea that a PSA of 4.0 ng/ml is some sort of cut off between a “good” PSA level and a “bad” PSA level is completely inaccurate. Your should have been getting a biopsy while your PSA was clearly rising and some time after it went over 2.5 ng/ml!


  4. According to Dr. Catalona, 25% of men with a PSA between 2.5 and 4.0 have prostate cancer; now, please let’s no go into this being aggressive prostate cancer or not.

  5. OK Wolfram, let’s not … but I would point out that according to Dr. Catalona PSA screening is currently saving 33,000 lives a year. I have been trying to work out how to make any statistical sense of that claim since he came up with it a few months before he gave a lecture on the subject at the AUA annual meeting earlier this year. As far as I am aware, absolutely no one else in the urology community (let alone the preventive services community) has been willing to endorse that particular claim.

    Since the majority of men with a PSA level between 2.5 and 4.0 ng/ml are probably over 50 years of age, and at least 40% of all men over 50 years of age do indeed have prostate cancer cells in their prostates, it is very possibly true that 25% of all men with a PSA level between 2.5 and 4.0 ng/ml “have prostate cancer” (if you define having prostate cancer as the presence of cancerous cells in the prostate) … but that doesn’t mean it is clinically significant, so it is a pretty pointless and clinically meaningless observation.

  6. During the 4 years prior to diagnosis in 2007 my PSA was tested every year, and it rose slightly every year, but never exceeded 4 ng/ml. At biopsy, all 12 needles showed adenocarcinoma, with 10 of the 12 cores showing 100%, high-grade disease (Gleason 8). Now I am post RP and castration resistant, and expecting to die within the next year or maybe two. I realize my anecdote is statistically insignificant, but I can’t help thinking that our present screening system might be slightly inadequate for detecting the aggressive version of this disease in time to do any good.

  7. Kevin:

    I think that “slightly inadequate” is perhaps a “slightly inadequate” description of the current situation. And yet I see little sign of any real progress that is absolutely focused on the early diagnosis of this type of truly aggressive prostate cancer.

  8. I saw a page in National Geographic showing a few cancer statistics. It showed that essentially as many men suffer from prostate cancer as women get breast cancer (both affect primarily one sex). However, breast cancer received more than twice the government (or National Cancer Institute research) funding as prostate cancer. In fact breast cancer (third highest death rate in period between 1990 and 2007) research recieved more NCI funding than prostate cancer PLUS lung cancer (these have the second and first highest death rates in that period) combined. That is the political reality of our government’s priorities — I wouldn’t trust them for a second when it comes to my own healthcare, whether it be screening advice or otherwise!

  9. Dear Matt:

    “The government” is responsive to the demands of voters. Women have been extraordinarily active in pressing their case for funding of breast cancer research over the years. By comparison, men with prostate cancer have been barely visible (or audible) and people with lung cancer tend to die before they can become highly politically active.

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