Newman says she is telling patients without risk factors that they can undergo biennial mammograms. “I’m worried about the person who hasn’t gone for five years,” she says, “not those who go every one to two years.”
Although neither the ACS nor the Preventive Services Task Force recommends routine prostate cancer screening—the prostate-specific antigen (PSA) blood test—citing insufficient evidence of its benefits, the disease arouses emotions as passionate as those involving breast cancer. Prostate cancer is the most common cancer in men, but the risk of dying from it is about 3 percent.
Jamie Bearse of Zero, a prostate cancer advocacy group, doesn’t regard PSA testing as a double-edged sword. “There is no such thing as overdiagnosis,” he says. “Overtreatment is the problem. Men need to get tested and know their PSA score. Everyone has the right to know if they have cancer.”
John Lynch, a prostate cancer survivor who chairs the department of urology at Washington’s Georgetown University Hospital, says he advises patients to undergo annual PSA testing.
But H. Gilbert Welch, a professor at the Dartmouth Institute of Health Policy and Clinical Practice, says he believes the risk of overdiagnosing prostate cancer far exceeds the potential benefits—he doesn’t plan to have a PSA test even though he is in his mid-50s.
“It’s a 50-to-1 ratio,” says Welch. “For every one man who avoids a prostate cancer death, 50 will be treated unnecessarily,” often because their cancers are so slow-growing that they will never cause problems. Considering the risks of incontinence and impotence from treatment, he adds, “to me, that’s not a good deal.” The fact that many men are being diagnosed with early-stage prostate cancer suggests many are being treated unnecessarily, he says.
To Dana-Farber’s Winer, the challenge is achieving a more nuanced view of cancer screening without confusing a public conditioned to believe in its unalloyed benefits. “This is like a great big cruise ship, not a little sailboat, in the way it moves.”
Sandra G. Boodman, a former staff writer for the Washington Post, writes about medicine and health for the Post and Kaiser Health News.