Two new studies published in the Sept. 25, 2009, online edition of BMJ —one by Benny Holmstrom, a urologist with Gavle Hospital in Gavle, Sweden; the other by Jennifer Stark, a research fellow at Harvard School of Public Health in Boston — highlight once again the lack of patient education regarding the risks associated with prostate cancer screening using the PSA blood test. According to Dr. Michael Pignone of the University of North Carolina at Chapel Hill, the chance of dying from prostate cancer for American men is 1 in 1,000. The chance of dying from heart disease, cancer or other causes is 113 in 1,000.
The British National Health Service first sounded the alarm two decades ago, declaring that routine PSA screening was costly, did not help men live longer or live better, and also subjected men to the risks of over-diagnosis and treatment for false-positive test results. Stanford University followed suit in 1987, calling PSA screening clinically useless. This year Harvard weighed in as well. In his 2004 book Should I Be Tested for Cancer, Maybe Not and Here’s Why, Gilbert Welch, M.D., professor of medicine at Dartmouth University, alerted readers to the lack of science validating routine PSA screening. Mass screening wastes money while endangering men’s quality of life. Targeted screening for men at high genetic risk, or for those with lifestyle risks, was suggested as a much more sound choice both medically and economically.
The two new studies point out that when a positive PSA test leads to a prostate biopsy, 75 percent of the time there is no cancer present. While men screened for prostate cancer are 2 to 4 times more likely to be diagnosed, the death rate from prostate cancer is the same for those screened as for those not screened. For men treated aggressively, the risks of consequent impotence and incontinence threaten quality of life.
Healthcare Reform as it presently exists won’t change the fact that the medical profession takes decades to abandon its harmful and wasteful practices. It’s long been medicine’s inside joke that it takes a generation of physicians to be trained, practice and die before meaningful change occurs. The American Cancer Society says it expects to alter its PSA recommendations next year. But why wait? When is the U.S. system of healthcare going to wake up?