The controversy over the advantages and disadvantages of screening for breast and prostate cancer highlights the pros and cons of the procedures.
Rethinking Breast and Prostate Cancer Screenings
An active discussion about screening for breast and prostate cancer came after Otis Bradley, M.D., chief medical officer of the American Cancer Society (ACS), told the New York Times during an interview on October 21, 2009 that:
"I'm admitting that American medicine has overpromised when it comes to screening. The advantages of screening have been exaggerated."
Dr. Brawley had written an essay that was published in the Journal of American Medical Association (JAMA) on October 21, 2009 about the need to rethink breast and prostate cancer screening. He argued that new approaches to screening for breast and prostate cancer are needed because the current methods have not led to a significant reduction in deaths from the two diseases.
The Case for a Rethink of the Cancer Screenings
In the essay for JAMA, written with Laura Esserman, MD, MBA, and Yiwey Sheif, AB, from the University of California, San Francisco, and Ian Thompson, MD, from the University of Texas Health Science Center, San Antonio, the authors call for a rethinking about cancer screening and offers a four-pronged program for improvement after realizing how similar prostate and breast cancers and their screening problems are. It is their opinion that mammography and prostate-specific antigen (PSA) testing, while admitting it has had some effect, has led to well-documented overdiagnosis and overtreatment of breast and prostate cancers.
In an interview with Medscape Oncology, Dr. Esserman said,
"We are not saying that screening is bad. It's what you do with the information that makes it good or bad. We need to refocus and figure out how to tailor screening."
According to Bob Smith, PhD, director of cancer screening for ACS,
"We have to do a better job to best inform the public about the benefits and harms of screening mammography."
Four-Point Plan for Improving Breast and Prostate Screening
In the essay published in JAMA, the authors lay out a four-point course for breast and prostate cancer screening that they believe will significantly reduce death and morbidity from the diseases:
- More powerful markers that identity and differentiate cancers with significant risks from those with minimal risk are needed.
- The treatment burden for minimal-risk disease must be reduced. Methods currently exist to identify low- and high-risk breast and prostate cancers. An example in the case of prostate cancer is that low-volume lesions with low Gleason scores have a low-risk for death. Minimal-risk disease should not be celled cancer; instead it should be called indolent lesions of epithelial origin (IDLE).
- Improved tools to support informed decisions are needed. Information about risks of screening and biopsy should be shared with patients before screening. Medscape Oncology reports that an estimated one third of PSA tests take place without even the most basic doctor-patient discussion.
- A great emphasis on prevention, including the use of proven cancer preventive agents, such as finasteride for preventing prostate cancer and tamoxifen and raloxifine for breast cancer is needed.
Dr. Bradley's beliefs are not without controversy. After the article was published and he was interviewed by the New York Times , ACS released an official press statement that quoted him as saying:
"While the advantages of screening for some cancers have been overstated, there are advantages, especially in the case of breast, colon, and cervical cancers. Mammography is effective - mammograms work and women should continue to get them."
The statement also included that ACS believes that men should make "informed decisions" about whether prostate screening is right for them.
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