The media are reporting that next week the United States Preventive Services Task Force (USPSTF) will issue new recommendations that advise healthy men to stop getting PSA tests for prostate cancer. Let the screening battles begin!

These recommendations follow those released in 2009 by the USPSTF on mammography screening, and I hope that they are better prepared this time than last time for the barrage of criticism they faced. But the bottom line is this: when it comes to PSA testing, the evidence shows that PSA testing does not save lives even though we initially hoped that it would and did!

I know this is not what we want to hear. We want to believe that if we can just find cancers early we can save lives. But the more we learn about cancer and how it works, the more we realize how much more complicated this is.

It turns out that you need more than a cancer cell to cause clinical life threatening disease. You need the cancer cell to be in an environment that is egging it along. We are all walking around with cancer cells. Our goal shouldn’t be to find every cell with the mutations of a cancer. Our goal needs to be to find the ones that are going to do us in.

Studies show that if you look hard enough you will find prostate cancer cells in about 30% of all 40-year-old men. Studies have also shown that about 30% of women who die of something else at age 50 have microscopic breast cancer cells. If we treat every one of these cells with shock and awe (surgery, radiation, and chemotherapy) as if it were going to kill us, we will suffer the collateral damage that all these treatments have, without the benefits.

It is time we go beyond wishful thinking like, If I just get this test, I will be saved! We need to be realistic and figure out a way to determine which cancer cells or what local environment will lead to serious disease and which cancer cells can be left alone because they will never do any harm.

We like simple messages like, early detection saves lives. But the real message is complex: Early detection of a clinically significant cancer will save lives, while early detection of a clinically insignificant cancer will only cause side effects without benefit. Of course, complicated messages like these don’t make great slogans. But I think the public  is smart enough to understand the truth. Don’t you?

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5 Responses to Not All Early Detection Saves Lives!

  1. ncw says:

    first of all, i agree with your blog title, not with the summary. having said that, i have some concerns that personally affect me. with this recommendation, is there any reference to the patients that are diagnosed at a late stage because of painful bone metastases, pathologic fractures, local bladder/bowel invasion, and impotence (from the disease and not the treatment) and the recourse they have against their pcp or urologist for failure to diagnose? until that occurs, this is a nonissue.

  2. Emma Ogens says:

    I do not believe that the USPSTF panel picked to determine what tests we should have or not have is their responsibility. They do not have expertise in athe areas. Look to see who is on the panel chosen by Kathleen Sebelius.

    Let the doctors do what they do best in their individual fields.

    The urologists and oncologists have no say.

  3. Dana Isherwood says:

    The PSA test alerts doctors that the patient should be monitored. Surgery and subsequent treatment are usually the result only after a long time of “watching”. Your blog made it sound as if a single cancer cell will trigger complicated treatment. Not true. The USPFTS had not a single urologist on its panel. In spite of their denial, this is another case of cost cutting.

  4. Dr Susan Love says:

    To ncw your issue is a different one, but often the biology of the tumor trumps the timing. To Dana Isherwood and Emma Ogens the people appointed to the USPFTs task force are chosen for their expertise in analyzing this kind of data. Physicians are trained to treat individual patients not to analyze large studies. The recommendations are for public policy. Obviously each person needs to discuss with their doctor what the right approach is for them based on the studies and the patient and the doctors experience.

  5. Helene Schonbrun says:

    Surviving is the ultimate goal, but aren’t there advantages to catching the cancer at an earlier stage (in terms of medication needed and lower risk of recurrence)? Even though I may have survived even if I had found my cancer at a later stage, it was a great benefit to have found it at Stage 1.

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