Posted on 11/18/2009 7:49:34 PM PST by neverdem
Controversy over the benefits of screening for breast cancer and prostate cancer hit the headlines and the blogosphere when the New York Times reported that the American Cancer Society is planning to temper its proscreening message for breast and prostate cancers, and a prominent representative of the society denied it on his blog.
By the end of the day, the society's chief medical officer, Dr. Otis W. Brawley, posted a firm statement that the ACS stands by its screening guidelines.
“The bottom line is that mammography has helped avert deaths from breast cancer, and we can make more progress against the disease if more women age 40 and older get an annual mammogram,” he wrote on the society's Web site.
“Since 1997 the American Cancer Society has recommended that men talk to their doctor and make an informed decision about whether or not prostate cancer early detection testing is right for them. This recommendation also still stands.”
Times reporter Gina Kolata had reported that the society is quietly working on a revision of its messages about the risks and potential benefits of breast and prostate cancer screening that would appear on the society's Web site in early 2010. The revision supposedly was a response, in part, to an article published in the Journal of the American Medical Association. In the JAMA article, Dr. Laura Esserman, director of the breast care center at the University of California, San Francisco, and her associates observed that 20 years of screening for breast and prostate cancers have not led to decreases in the incidence of late-stage breast and prostate cancers that screening provides for some other types of cancers (JAMA 2009;302:1685-92).
At the same time, many people get treatment that probably isn't needed, wrote Dr. Esserman along with Dr. Ian Thompson, chairman of the department of urology at the University of Texas Health Science Center, San Antonio, and Yiwey Shieh, a medical student at UCSF.
Dr. J. Leonard Lichtenfeld, deputy chief medical officer for the ACS, wrote in “Dr. Len's Cancer Blog” that the front-page article in the New York Times “has created a firestorm of media interest” that he feared would be misinterpreted. He flatly denied that ACS is “working on any stealth project” to increase discussion about the shortcomings of screening.
“..many people get treatment that probably isn’t needed..”
I have a very good genetic background. Nonetheless, I try to exercise every day although that probably isn’t needed either. Nobody ever said that an M.D. degree automatically confers common sense and this guy proves it.
How about: Stop getting abortions!
Just think how many people don’t have a clue about this or anything else going on.
I have a very good genetic background. Nonetheless, I try to exercise every day although that probably isn’t needed either. Nobody ever said that an M.D. degree automatically confers common sense and this guy proves it.
It's not a simple subject complicated by risk factors, false positives, further testing, adverse effects and complications of treatment, etc. When you think of all women without risk factors between 40 and 49 years of age getting screening mammography, it's not an unreasonable comment. The truism that getting an earlier diagnosis is better has not been found to be always true.
Now an individual with cancer or the family member of a loved one with cancer is going to say what are you talking about? These controversial recommendations only address population subgroups. It's something like prognoses for a particular diagnosis. Those odds are based on studies of large numbers of patients. How any one patients fares is the luck of the draw. No doc can guarantee a good result.
Here's the title and link to the JAMA abstract of the original article, and then links to the NY Times article explaining it, and two more articles.
Rethinking Screening for Breast Cancer and Prostate Cancer
Cancer Society, in Shift, Has Concerns on Screenings
Less is more in new breast-cancer screening
Study Confirms Value of Routine Mammograms
It bad enough to have conflicting medical advice. It's even worse when politics involves medicine.
“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.”
Dr. Brawley says mammograms can prevent some cancer deaths. However, he says, “If a woman says, ‘I don’t want it,’ I would not think badly of her but I would like her to get it.”
******
Women in their 40s should not get routine mammograms for early detection of breast cancer, according to updated guidelines set forth by the U.S. Preventive Services Task Force.
“All we are saying is, at age 40, a woman should make an appointment with her doctor and have a conversation about the benefits and harms of having a mammography now versus waiting to age 50,” said Dr. Diana Petitti, vice chair of the task force.
“With its new recommendations, the [task force] is essentially telling women that mammography at age 40 to 49 saves lives; just not enough of them,” Dr. Otis Brawley, chief medical officer for the American Cancer Society.
******
Experts at the University of Texas M. D. Anderson Cancer Center also voiced concern and said they aren’t changing their screening protocol. “We disagree with their conclusions,” Dr. Therese Bevers said of the task force. “You have to screen more women. It’s the value we put on zero women dying.”
“Certainly mammography does pick up things at [age] 45 that would have been much more serious in five years,” said Dr. Anne Wallace, director of the University of California-San Diego Moores Breast Cancer Program. “What worries me is if insurance companies won’t allow women who want early detection in this age group to be screened.”
Susan Pisano, spokeswoman for American Health Insurance Plans, says insurance providers may revisit how they measure health plan’s performance based on the updated guidelines
Lately The American Cancer Society is starting to sound more and more like AARP.
just an observation
Dr. Otis Brawley
Compares Prostate Screening to Tuskegee Experiment
Opposes Prostate Cancer Awareness Stamp, Says Post Office Should Deliver Mail, Not "Misleading Advice"
Otis Brawley: I have never had a PSA and do not desire one. I have had relatives with the disease. I just do not believe it saves that many lives.
Dr. Diana Petitti
Dr. Diana Petitti joined ASU in 2008 after a career that included positions with the Centers for Disease Control as a field epidemiologist, 10 years as a member of the full-time faculty in the Department of Family and Community Medicine at the University of California San Francisco
******
Dr. Petitti was more explicit about the issue of ‘breast self- examinations’. “Women should know it doesn’t work. Two large studies published since the last guidelines involving 200,000 women in China and more than 100,000 in Russia showed no benefits from breast cancer self examinations.”
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Just seven years ago the task force recommended that women should have mammograms every one to two years once they turn 40. This influential group, appointed by the Department of Health and Human Services, provides guidelines for doctors, insurance companies and policy makers.
******
Dr. Diana Petitti & others say the advisory panel didn't require a breast cancer specialist; the panel had sufficient expertise.
ping
The doctor on Glenn Beck’s show just said that this government group who made this recommendation determines what the government covers.
The government will not cover mammograms so Sebulius lied (again).
Best analysis yet.
Get people used to it now.
LOL - liberals were soooooo anxious to play their death cards - they shot off prematurely ... Now the people have a small pretaste of what ObamaCare is really going to be like... and it’s not going down well...
Still waiting to hear from NOW . . . .
BUMP-TO-THE-TOP!
This is a totally political move based on cost. The UK with their rationing by NICE led this movement. And what happened to Zero increasing screening tests before people are sick?
This is what happens when the government gets their hands on healthcare and politicizes it.
Why don’t they cut HIV/AIDS spending? That is a PREVENTABLE disease!
Thanks for the ping!
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