Cancer Screening: Another View

As you might expect, my column pointing out the limits of cancer screening and early detection was not universally greeted with hosannas. Many people cling fiercely to the notion that screening will save their lives. When I wrote the column, I wasn't aware of a smart blog post  from March 18 by the American Cancer Society's "Dr. Len"--J. Leonard Lichtenfeld--who does a terrific job analyzing the two recent prostate-cancer-screening studies that were so disappointing.

He notes the two studies' methodological flaws (men in the non-screening group got screened, for instance), but then reaches a striking conclusion. Like many oncologists and cancer researchers, Lichtenfeld had eagerly awaited the results of the European and American prostate-cancer-screening studies, expecting (or at least hoping) they would once and for all answer the question of whether the PSA test saves men's lives. Unfortunately, he writes, "I don’t know that we now have any better idea whether or not prostate cancer screening actually works. . . .  At first blush, my reaction was that these studies don’t really give us the answer we were waiting for.But on further reflection, maybe they did. . . Perhaps not getting a clear answer to the question as to the value of prostate cancer screening is in fact a clear answer." For if the mortality-reducing benefits of PSA screening are so small that they can be made to appear and disappear depending on a study's methodology, those benefits are falling way short of what we all hoped.

On one point, however, the cynical me has to disagree with Dr. Len. He writes, "I suspect the 'gung-ho go forward at any cost' attitude of those in the medical and advocacy communities who have promoted prostate cancer screening with a vengeance—absent evidence that it really saved lives—is going to calm down just a bit." That, I just don't see--not until oncologists come up with something else that will give men the illusion of control over their health and their life.

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