Questions about the potential harm of breast and prostate cancer screening are not new. In fact, in the past 12 months, more and more studies have come out concluding that PSA screening and mammography may overdiagnose patients. Most of the patients screened and confirmed to have prostate cancer do not go on to have aggressive, lethal cancers. Preceding that were years of debate in journal reports and medical meetings.
On Sept. 22, I described where the major MD organizations are on this issue, and how jarring it would be to envisage an upside to not getting screened.
So it didn't surprise me earlier this week when Gina Kolata's New York Times article punched up the issue and made Otis Brawley, MD, Chief Medical Officer of the American Cancer Society, sound like he spoke out of turn.
Brawley had this to say: "We don't want people to panic. But I'm admitting that American medicine has overpromised when it comes to screening. The advantages to screening have been exaggerated."
By late afternoon, the ACS' Brawley tempered the comment, and the next morning's paper ran a lukewarm piece with the headline "Benefits and Risks of Cancer Screening Are Not Always Clear, Say Experts."
Research has shown repeatedly that doctors don't know how to talk about potential over-diagnosis to their patients, and so they don't. When patients read these articles, they see the information as little more than coming out of personally charged individuals.
I wonder how much good Kolata's article did when she set the stage for a food fight, or alternatively, when the press buys the line put out by The Times the next day that readers may be too stupid or confused to get it.
Conflict over PSA screening has been simmering for a very long time. This week, it rose to a fever pitch. I wonder what it will take for evidence to prevail. The ACS clinical practice guidelines have been posted on its website for a very long time. Brawley reiterated ACS' position about the uncertainties of PSA screening in detecting clinically significant, aggressive cancers.
Even the flagship American Urological Association acknowledges the uncertainties of PSA screening and prominent urologists have expressed skepticism on broadcast news.
The press owes it to its readers to treat them like they are not watching a side show and tell the story clearly. Doctors owe it to their patients to discuss these difficult issues.