There are a lot of problems with cancer screening. Explaining and understanding the calculus behind the tests is not easy. Suffice to say that early detection is generally not the life saver we thought it would be.
Now comes a steep decline in prostate cancer diagnoses. Harvard’s Meir Stampfer asks where that’s good news or bad news. Writing mostly behind the pay wall in JAMA Oncology he notes:
Prostate cancer rates in the United States are down—sharply… a decline of 53% since 1992, when prostate-specific antigen (PSA) screening became widespread. This decrease is likely attributable to 2 factors. First, after more than 3 decades of widespread PSA screening to detect prostate cancer, there are few men with high PSA levels that haven’t already been diagnosed. Second, and perhaps more important, PSA screening is now becoming less common.In 2008, the US Preventive Services Task Force (USPSTF) advised against PSA screening for men older than 75 years. Screening then declined in all age groups.
The questions is, he ask –will drop in mortality stop or reverse as screening declines?
Stampfer note that here is a lot of undiagnosed prostate cancer out there. Most cases, he writes, will never cause harm. Some will, but the PSA test is not specific enough to sort out the lethal cases. Watch at wait is one response. But, if the cases are never diagnosed, no one will be watching.
So, good or bad news? He’ll address that question on Wednesday, January 10, at the Harvard School of Public Health. Details here.
Worth noting that, according to Health News Review, a recent study “confirms what we already know about the PSA test — that it involves trade-offs including financial costs and long-term harms from screening in exchange for what appears to be very few numbers of lives saved. It is in knowing and understanding these trade-offs that men can be sure that they are going into a PSA test with their eyes wide open.”