Eg. The United States Preventative Services Task Force (USPSTF) made a final recommendation on May 21, 2012 which aligned consistently with the draft recommendation publicly announced on October 7, 2011.
The recommendation is against prostate-specific antigen (PSA) based screening for healthy men, asserting that there is “moderate or high certainty that the service has no benefit or that the harms outweigh the benefits,”
VS -The American Urological Association, on the other hand, says the decision to undergo PSA testing should be individualized. Last year, the group criticized the USPSTF for doing "a great disservice by disparaging what is now the only widely available test for prostate cancer."
Medicine has a precedent of handling predictive tests poorly. Consider the PSA test, which detects a protein linked to prostate cancer. Not only does the test produce false positives a majority of the time, but some of the tumors it actually detects are so slow-growing that they aren’t worth treating. Millions of men have ended up getting treated for cancers that ultimately wouldn’t have affected them. By one estimate, for every 47 men who had their prostates removed, a single cancer death was avoided. Studies by researchers at Dartmouth College suggest that mammography also leads to overdiagnosis and overtreatment. About 25 percent of breast cancers discovered, and treated, would not have caused any symptoms. “You test everyone and end up treating people for diseases that would never have mattered, either because they wouldn’t have progressed or because people die of something else,” says Jonathan Skinner, a health economist at Dartmouth. “The downside of early screening can be very high.”
ReplyDeletePSA Test Is Misused, Unreliable, Says the Antigen's Discoverer. Medscape. Aug 08, 2014
ReplyDelete"...n the book, I talk about 4 cruxes that explain why the PSA test is not being used appropriately. First, the PSA test is not cancer-specific. Second, there is no cut-off, no dichotomy in the response for a certain PSA level. For many years, we used 4 ng/mL, but we now know that a man can have a PSA of 0.5 ng/mL and have cancer, or a PSA of 11 ng/mL and not have cancer.
ReplyDelete...Third, we can't tell the difference between latent cancer or nonclinical cancer and aggressive cancer. I make the analogy in the book of a rabbit and a turtle and an open box. The turtle crawls around the box and goes nowhere. That's the nonaggressive, indolent cancer. The rabbit, representing the aggressive cancer, can jump out of the box and metastasize anytime. The problem is, we can't tell the difference between a rabbit and a turtle.
The most important crux is that prostate cancer is an age-related disease. If you get, for example, 100 men -- black or white -- between the ages of 60 and 69 years and do biopsies, you will find that 65% of these men have prostate cancer because it's age-related...." -Richard J. Ablin, PhD, DSc (Hon), who first discovered prostate-specific antigen (PSA) in 1970.
References
ReplyDeleteAblin RJ, Piana R. The Great Prostate Hoax: How Big Medicine Hijacked the PSA Test and Caused a Public Health Disaster. New York: Macmillan Publishers; 2014.
Carter HB, Albertsen PC, Barry MJ, et al. Early detection of prostate cancer: AUA guideline. J Urol. 2013;190:419-426. Abstract
Ablin RJ. The great prostate mistake. New York Times. March 9, 2010. http://www.nytimes.com/2010/03/10/opinion/10Ablin.html?_r=0 Accessed July 25, 2013.
Topol E. The Creative Destruction Of Medicine: How the Digital Revolution Will Create Better Health Care. New York: Basic Books; 2013.
Moyer VA; US Preventive Services Task Force. Screening for prostate cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2012;157:120-134. Abstract
Help or harm. The Economist. March 8, 2014. http://www.economist.com/news/books-and-arts/21598622-furious-debate-over-screening-prostate-cancer-help-or-harm Accessed July 24, 2014.