Could the decline in #prostatecancer diagnoses usher in an increase in death rates? #cancer screening

CaptureThere 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.

He cites a study release this past fall, that found screening reduces mortality. It follows another study that found no reduction.

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.”

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5/7: Boston health events this week

Thanks to Boston Science and Engineering Lectures for listings. We  urge you to double-check the “Details” links for changes and cancellations and to note the asterisks regarding limited access to some events.

Tuesday

4898606253_4e2af86630_m2p.  “Recent Insights into the Protein Biology of Alzheimer’s and Parkinson’s Diseases.”  Dennis J. Selkoe.   Brigham & Women’s:  Building for Transformative Medicine, 3rd Floor Conference Space, 60 Fenwood Road.   Details.*

3:30 “Digital Transformation in Healthcare & Telehealth for One Sixth of Humanity: The Apollo Story.”   K. Ganapathy and Sushant Tripathy.   MIT:  66-144.   Details, Abstract.   This event will be streamed.mclean-jpg

4:30 – 6:30p.  “Sleep: What You Need and How to Get It.”   A panel discussion.   MIT:  E51, Wong Auditorium.   Details.

Thursday

12:30p.  “Supplements and Health: Sorting the Facts.”   A panel discussion.   HSPH:   The Leadership Studio.   Details, Abstract, Registration.   This event will be streamed. RSVP to attend

Friday

7 – 1p.  “Massachusetts Prostate Cancer Symposium.”   Boston Marriott Copley Place.  Details, Registration.

*Admission to buildings in Harvard’s medical area often requires ID issued by a “Harvard Medical School Affiliate”.  Persons interested in events in the medical area that are not explicitly public,  do not invite registration, might want to email the person cited in the details page.\

Coffee and prostate cancer: Not what you think

That wacky comic hero Too Much Coffee Man will rejoice!

A new Harvard study has found that men who drink 1 to 3 cups of coffee a day had a 20 percent lower risk of serious prostate cancer than non-coffee drinkers. The risk is 25 percent lower for those who 4 or 5 cups.

As Bloomberg reports:

In research involving 50,000 men over 20 years, scientists led by Kathryn Wilson at Harvard’s Channing Laboratory found that the 5 percent of men who drank 6 or more cups a day had a 60 percent lower risk of developing the advanced form of the disease than those who didn’t consume any.

Hear us now — This does NOT mean coffee prevents prostate cancer. All this type of study measures is correlation — not cause and effect. But, that’s a pretty strong correlation.

And, don’t get all hyper about it. Decaf had the same effect.

Screening for Cancer Questioned

BHN thinks this it is huge that the American Cancer Society finally admitted that cancer screening sometimes leads to overdiagnosis.

Or did they? This blog item from the Associations of Health Care Journalists notes that ACS backpedaled a day after the NYTimes reported on the society’s change of heart. Check out their links too.  

(Times writer Gina) Kolata’s story was published on Tuesday. On Wednesday, the ACS released a statement from Brawley in which he says the organization stands by its screening recommendations.

Here’s why the mantra  of early detection is a problem. We’ve gotten better at finding cancer but we are not very good at sorting the nasty ones out from the tumors that will never grow. If you have a raging tumor, it doesn’t seem to matter when you find it. And, yes, some malignant tumors –possibly quite a few — never grow.  The concept of early detection was a very successful health campaign. Too bad, in many cases, it was wrong.

Gary Schwitzer of  University of Minnesota School of Journalism believes in evidence-based reporting.  He’s been following the follow-ups on this story and isn’t happy.

New media writer Jeff Jarvis, recently diagnosed and treated for prostate cancer, is writing about screening again: “I say, thank god science for screening.”

 He’s entitled to his opinion. He is not entitled to his own personal version of the facts. He writes: “There is a growing rumble about curtailing screening.”

 No. That is simply wrong. There is no move for “curtailing” screening. There are many, however, who are calling for better and more balanced presentation of the potential harms – not just the potential benefits – of such screening.

The debate over mammography and prostate cancer screening has been around for a while. According to the National Women’s Health Networkfifteen years after the debate about the value of screening mammography first flared up, too many women (and clinicians) still don’t know it’s more complicated than the “early detection is your best prevention” slogan.

The stories of note from the NYTimes. 

 Benefits and Risks of Cancer Screening Are Not Always Clear, Experts Say

Most people believe that finding cancer early is a certain way to save lives. But the reality of cancer screening is far more complicated.

Studies suggest that some patients are enduring aggressive treatments for cancers that could have gone undetected for a lifetime without hurting them. At the same time, some cancers found through screening and treated in the earliest stages still end up being deadly.

As a result, the chief medical officer for the American Cancer Society now says that the benefits of early detection are often overstated. The cancer society says it will continue to revise its public messages about cancer screening as new information becomes available.

And, Gina Kolata’s 10/21 story

The American Cancer Society, which has long been a staunch defender of most cancer screening, is now saying that the benefits of detecting many cancers, especially breast and prostate, have been overstated.

It is quietly working on a message, to put on its Web site early next year, to emphasize that screening for breast and prostate cancer and certain other cancers can come with a real risk of overtreating many small cancers while missing cancers that are deadly.

“We don’t want people to panic,” said Dr. Otis Brawley, chief medical officer of the cancer society. “But I’m admitting that American medicine has overpromised when it comes to screening. The advantages to screening have been exaggerated.”

As far as mammography goes, Breast Cancer Action has been all over this. In honor of Breast Cancer Awareness month, check out their “Think Before You Pink” campaign while you’re at it.