Value of Mass Prostate Cancer Screenings Questioned

By Brawley, Otis | St. Joseph News-Press, March 14, 2012 | Go to article overview

Value of Mass Prostate Cancer Screenings Questioned


Brawley, Otis, St. Joseph News-Press


(CNN) -- Q: The New England Journal of Medicine has published more information on prostate cancer screening. Why is it so controversial? A: Approximately 28,200 American men will die of prostate cancer in 2012. Among cancers, only lung cancer kills more men in the U.S. each year.

This week's issue of the New England Journal of Medicine has a follow-up evaluation of The European Randomized Study of Screening for Prostate Cancer (ERSPC), which analyzed data from 162,000 men.

The ERSPC study concluded that screening reduced an individual's relative risk of prostate cancer death by 21%.

Many will quickly interpret this to mean that prostate screening with the blood test known as PSA saves lives. But the paper deserves a deeper examination, as the findings are not that simple.

Prostate cancer screening has been common in the U.S. since the early 1990s. Mass prostate screening, where large numbers of men are encouraged to get the test at health fairs, shopping malls and community meetings has become a lucrative part of the business plan for many hospitals, clinics and medical practices. So it's surprising to note that the 2009 ERSPC publication was the first well-designed clinical trial to even suggest that screening saves lives.

The ERSPC reported a 21% decrease in relative risk of death in 2009. Put into perspective, a 21% decline in relative risk means that a man choosing screening goes from a lifetime risk of prostate cancer death of 3% to a lifetime risk of 2.4%. Here they found that 1,055 men would need to be screened to identify 37 men with prostate cancer and save one life.

To be fair, not all accepted cancer screening tests have demonstrated a decrease in overall mortality.

Trials have shown breast cancer mammography has met this standard, as has lung cancer screening using low dose spiral CT.

I am aware of no cervical cancer or colorectal cancer screening studies showing a decrease in overall mortality, but many have shown a decrease in the incidence of disease. Reducing the number of people getting the cancer is another accepted benefit of screening. Q: Why do we need a new study of prostate cancer screenings? A: The purpose of a screening test is to save lives. A test is not necessarily successful in saving lives if it simply finds cancer. I believe it is not necessarily a successful test it finds disease earlier and leads to an increase in the number of people surviving five or 10 years after diagnosis. …

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