While I am a big proponent of wellness and prevention, the push for cancer screening in this country may have been taken to excess. As The New York Times reported earlier in the summer (July 17, 2009), there is ample evidence that routine exams offer little benefit to the general public and cost our healthcare system wasteful dollars in multiple ways.
One of the more controversial discussions at present is between urologists and family physicians. The American Urological Association (AUA) launched this summer a prostate cancer awareness campaign featuring celebrity status, professional football players urging annual screenings. Meanwhile, family physicians argue that population-wide screening may cause as many as half of all men to undergo treatments and procedures that do not improve health and do not save lives. This is based on evidence from extensive research completed in Europe on the subject. Moreover, such steps can be costly in various ways, causing adverse events such as impotence, urinary incontinence, and bowel control problems. Aside from the calamities and stress inflicted on patients, there is the economic cost, estimated at $700 billion annually for unneeded treatments of all types resulting from such screenings.
Click on the link to learn more about the problems that can occur following treatment for a diagnosis of prostate cancer. I cannot help questioning whether we have a juxtaposition of different drivers influencing opinions: urologists on the one hand who are compensated for each procedure they undertake versus family practice doctors who are rewarded for efficiency of patient visits, free of the aftermath of diagnostic and procedural complications.
What really needs to happen is better targeting of the at-risk population and better prevention measures in general undertaken by the public. It all begins with public health education. Genetic factors are linked to prostate cancer now, such that we know African American men are more highly susceptible to the cancer than others. Obesity has been linked to the risk of prostate cancer as well. There has long been evidence, just as with breast cancer, that heredity is a consideration as well. Do all Americans know their family medical history and share it with their doctors? Many don't even keep track of their own!
Screening is justified when a life-threatening form of cancer that responds well to timely intervention can be readily and safely identified. Two such examples are the evidence for cervical and colon cancer screening. Women with certain risk factors such as DES exposure before birth, HIV infection or a weakened immune system should especially adhere to a routine of annual screenings. On the other hand, women 70 or older who have had three or more normal Pap tests in a row and no abnormal results in the last 10 years can stop having cervical cancer screenings. Since colon cancer is the third leading cause of death in women, a colonoscopy is recommended every 10 years, beginning at age 50. Should polyps be discovered, the test should be repeated every five years so that precancerous growths can be identified and removed.