Alannah Tomich
PH150D-LTE Assignment
Letters to the Editor
New York Times
letters@nytimes.com
October 6, 2011
Dear Editor,
Today’s article, U.S. Panel Advises Against Routine Prostate Test, is particularly relevant as we look forward to the new emphasis on preventative medicine in federal health reform.
Having lost a grandfather to prostate cancer and celebrating two years since my father’s successful surgery, the terrifying impact of prostate cancer is personal. Nonetheless, I support the task forces recommendation.
As a public health student, I study how screening for a disease before symptoms appear is an integral part of prevention. However, this only makes for better medicine if early treatments offer better outcomes. These new studies are important to show us that current prostate cancer screening tests are not effective in reducing mortality and, in fact, decrease patients’ quality of life.
While our health system uses recommendations like this one to provide information to physicians, decision making based on specifics of the individual patient’s case must also be emphasized.
To your health,
Alannah Tomich
Undergraduate Public Health Student
University of California, Berkeley
atomich@berkeley.edu, 530-574-7236
Original Article. Available at: http://www.nytimes.com/2011/10/07/health/07prostate.html?hp
U.S. Panel Advises Against Routine Prostate Test
By GARDINER HARRIS
Published: October 6, 2011
Healthy men should no longer receive a P.S.A. blood test to screen for prostate cancer because the test does not save lives over all and often leads to more tests and treatments that needlessly cause pain, impotence and incontinence in many, a key government health panel has decided.
The recommendation, by the United States Preventive Services Task Force and due for official release early next week, is based on the results of five well-controlled clinical trials and could substantially change the care given to men 50 and older. There are 44 million such men in the United States, and 33 million of them have already had a P.S.A. test — sometimes without their knowledge during routine physicals.
The task force sets policy for the government, and most medical groups follow its recommendations. Two years ago the task force recommended that women in their 40s should no longer get routine mammograms, setting off a firestorm of controversy. The recommendation to avoid the P.S.A. test is even more forceful and applies to all men, not just those in their 40s.
“Unfortunately, the evidence now shows that this test does not save men’s lives,” said Dr. Virginia Moyer, a professor of pediatrics at Baylor College of Medicine and chairwoman of the task force. “This test cannot tell the difference between cancers that will and will not affect a man during his natural lifetime. We need to find one that does.”
But the baseball great Joe Torre, the financier and philanthropist Michael Milken and Rudolph W. Giuliani, the former New York City mayor, are among tens of thousands of men who believe a P.S.A. test saved their lives, and advocates for those with the disease promised to fight the recommendation. The task force can also expect resistance from some drug makers and doctors. Treating men with high P.S.A. levels has become a lucrative business. Some in Congress have decried previous decisions by the task force as akin to rationing, although the task force does not consider cost in its recommendations.
“We’re disappointed,” said Thomas Kirk, president and chief executive of Us TOO, the nation’s largest advocacy group for prostate cancer survivors. “The bottom line is that this is the best test we have, and the answer can’t be, ‘Don’t get tested.’ ”
But that is exactly what the task force is recommending. There is no evidence that a digital rectal exam or ultrasound are effective, either. “There are no reliable signs or symptoms of prostate cancer,” said Dr. Timothy J. Wilt, a member of the task force and a professor of medicine at the University of Minnesota. Frequency and urgency of urinating are poor indicators of disease, since they often result from a benign problem. The first real sign of cancer is often bone pain from the cancer’s spread, Dr. Wilt said.
The P.S.A. test measures a protein — prostate-specific antigen — that is released by prostate cells, and there is little doubt that it helps to identify the presence of cancerous cells in the prostate. But a vast majority of men with such cells never suffer ill effects because their cancer is usually slow-growing. Even for men who do have fast-growing cancer, the P.S.A. test may not save them since there is no proven benefit to earlier treatment of such invasive disease.
As the P.S.A. test has grown in popularity, the devastating consequences of the biopsies and treatments that often flow from the test have become increasingly apparent. From 1986 through 2005, one million men were treated with surgery, radiation therapy or both who would not have been treated without a P.S.A. test, according to the task force. Among them, at least 5,000 died soon after surgery and 10,000 to 70,000 suffered serious complications. Half had persistent blood in their semen, and 200,000 to 300,000 suffered impotence and urinary incontinence. As a result of these complications, the man who developed the test, Dr. Richard J. Ablin, has called its widespread use a “public health disaster.”
One in six men in the United States will eventually be found to have prostate cancer, making it the most common form of cancer in men other than skin cancer. An estimated 217,730 men received the diagnosis last year, and 32,050 died. The disease is rare before age 50, and most deaths occur after age 75.
Not knowing what is going on with one’s prostate may be the best course, since few men live happily with the knowledge that one of their organs is cancerous. Autopsy studies show that a third of men ages 40 to 60 have cancer of the prostate, a share that grows to three-fourths above 85 years.
P.S.A. testing is most common in men over age 70, and it is among elderly men that it is the most dangerous, since such men routinely have cancerous prostate cells but benefit the least from surgery and radiation, the usual treatments.
The task force’s recommendation against P.S.A. testing applies only to healthy men without symptoms. The group did not consider whether the test is appropriate in men who already have suspicious symptoms or those who have already been treated for the disease.
