U.S. Preventive Services Task Force screening does more harm than good
The PSA test used mainly to screen for prostate cancer. The test measures the amount of prostate-specific-antigen (PSA) in the blood.
PSA testing has been in controversy over the years. The American College of Preventive Medicine had concluded that there was insufficient evidence to recommend the screening. Even the New England Journal of Medicine in 2009, published results from two large studies of the screening procedure. The study done in the U.S. demonstrated that over a span of seven to ten years, screening did not reduce the rate of death in men over 55. The European study had revealed that the screening reduced the death rate by 20% but was linked to a higher risk of over diagnosis.
Now, this long heated controversy is coming to a close as the U. S. Preventive Task Force (an independent panel of experts) has voted no to the testing citing the test are too unreliable as they deliver a false positive 80% of the time nor does it outweigh the harm that comes from positive test results such as unnecessary surgery and radiation that could result in major side effects like incontinence and even death. Due to the needless suffering from these European countries that includes the United Kingdom do not have routine PSA screening.
Dr. Virginia Moyer, MD, professor pediatrics, Baylor College of Medicine and chairwoman for the task force, noted that the PSA usually results in unnecessary needle biopsies for men who actually do not have cancer. Dr. Moyer further remarks that treating harmless prostate tumors cannot possibly help men. She notes it increases the odds for negative health effects such as incontinence and that treatment can be deadly she adds one in 200 men who have prostate surgery die shortly after the procedure.
Dr. Moyer states “We want to screen for new ones that are going to be aggressive, manage those early and leave everyone else alone.”
Some experts agree with the task force up to a point as in the case of Dr. Ian Thompson, MD, University of Texas, canary prostate team and professor and chair of the department of urology at the University of Texas Health Science Center, San Antonio, and spokesman for the American Urological Association. Dr. Thompson agrees with some points such as to end mass screenings which are done in places like shopping malls. However, he believes the task force went overboard by doing away with the test altogether. He further adds he does not want to go back to ‘the bad old days” before screening when doctors found the cancer when it was too late.
Due to the tests often showing a false positive and the fact it does not reveal how aggressive or benign a cancer could be it casts a cloud above the heads of doctors and patients wondering if the tumor does need to be treated. The task force notes “many men are being subjected to the harms of treatment of prostate cancer that will never become symptomatic. PSA-based screening for prostate cancer results in considerable overtreatment and its associated harms.”
Dr. Otis Webb Brawley, MD, chief medical officer and executive vice-president of the American Cancer Society, defends the task force decision and stated in a written editorial “Many have a blind faith in early detection of cancer and subsequent aggressive medical intervention whenever cancer is found.” “There is little appreciation of the harms that screening and medical interventions can cause,” according to reports from MSNBC.
Dr. Brawley notes that most men will get prostate cancer if they live long enough with about 240,000 American men each year diagnosed with prostate cancer but most have slow growing tumors that carry very low risk that will change into the kind that will kill.
The best advice among some experts is to talk to your doctor about the PSA and the pros and cons to it before you make a decision.
Do you believe the task force made the right decision for men or are they just playing Russian roulette with lives of men?