American Cancer Society Stands By Cancer Screening Guidelines

WEDNESDAY Oct. 21, 2009 -- The American Cancer Society says it is not currently rethinking its stance on cancer screening, as was widely reported Wednesday.

"We are not redoing or rethinking our guidelines at this time, nor are we going to restate our guidelines to emphasize the inadequacies of screening," said Dr. Len Lichtenfeld, deputy chief medical officer of the American Cancer Society.

The society continually revises its screening recommendations and issues new guidelines every year, usually in January. Moreover, current guidelines do not minimize any problems with screening, Lichtenfeld stated.

"We have always been talking about the limitations of screening," he said. "That's not really news."

For instance, the cancer society revised its prostate cancer screening guidelines several months ago to emphasize the fact that it does not recommend PSA screening for everyone but does recommend that men have "informed discussions with health-care professionals before embarking on a screening program," Lichtenfeld said.

Also, the cancer society has never maintained that mammography screening for breast cancer is perfect. "Mammography misses lesions. We know that we do find more lesions than might otherwise cause a woman harm, but that's something we've known and talked about for a long time," he said.

A report published Wednesday in The New York Times said that the American Cancer Society was planning to post a message on its Web site early next year delineating the risks of overtreatment resulting from excess screening. Responding to the article, Lichtenfeld said that "I'm not aware of that and if it was, in fact, happening, I would have knowledge of it."

In an official statement released Wednesday, the cancer society acknowledged that the "advantages of screening for some cancers have been overstated," but also added that "there are advantages, especially in the case of breast, colon and cervical cancers."

The statement, from the society's chief medical officer, Dr. Otis Brawley, said that the organization "stands by its screening guidelines" and that "women are encouraged to continue getting mammograms."

The apparent confusion stems largely from popular media reports that, in turn, seemed to have been spurred by an opinion piece published in the Oct. 21 issue of the Journal of the American Medical Association (JAMA).

A press release accompanying the JAMA article included quotes from Brawley, agreeing with the authors' conclusions.

According to the JAMA authors, from the University of California, San Francisco, and the University of Texas Health Science Center at San Antonio, increased screening rates for breast and prostate cancers have resulted in more diagnoses but have not translated into correspondingly lower death rates, incurring "potential tumor over-detection and over-treatment," the researchers wrote. Although mortality from cancer in general has decreased, the authors conceded, it's unclear how much of this is because of more screening.

Why might increased screening not translate into saved lives, as the two experts contend? Probably because more aggressive tumors are still not found in time to save the patient, according to one specialist.

A major issue facing oncologists, especially for breast and prostate cancers, is being able to separate the very bad cancers from the less dangerous tumors.

"The problem is, we have a hard time at this point differentiating cancers that are going to hurt someone and cancers that are not going to hurt someone in their lifetimes," said Dr. Jay Brooks, chairman of hematology/oncology at Ochsner Health System in Baton Rouge, La. "I think screening for various cancers is extremely helpful, and I do believe they have made major public health inroads. What we're trying to do is to fine-tune the screening techniques."

The stage of a person's life, not just the stage of the tumor, has to be taken into account, Brooks said.

"For the man in his 50s whose PSA [prostate-specific antigen] level rises abruptly, that's probably significant. But for the man in his 70s or 80s who has other diseases, probably PSA testing is not a good idea," Brooks added. "Same thing with mammography. If a woman is diagnosed in her 20s, that's probably a significant finding. However, if you're 80 and have dementia, that's probably not a good thing to be doing."

The American Cancer Society currently recommends that all women over age 40 get an annual mammogram. Women at high risk should talk with their physicians about an optimal screening plan.

The society also advises that men talk to their doctor about "whether or not prostate cancer early detection testing is right for them," the cancer society statement read. "This recommendation also still stands."

Kathryn Taylor, associate professor in the Cancer Control Program at Georgetown University's Lombardi Comprehensive Cancer Center, said that "we tell men that there's no right or wrong answer [regarding PSA testing] at present, and it really comes down to a personal choice. And the onus, unfortunately, is on them to really educate themselves about the potential benefits as well as the potential harms."

One of those potential harms is overdiagnosis, added Taylor, who develops patient-education materials to inform men about the pros and cons of prostate screening.

According to the JAMA piece, about half of at-risk men now undergo regular PSA tests, while 70 percent of women over the age of 40 said they had recently had a mammogram.

The availability of PSA testing "has nearly doubled the chance that a man will be diagnosed with prostate cancer in his lifetime," wrote the authors of the JAMA paper.

The chance that a woman will be diagnosed with breast cancer sometime in her lifetime has risen from one in 12 in 1980 to one in eight today, the authors stated.

More than 800 women would have to be screened over a period of six years to avert one breast cancer death, the authors of the JAMA paper said.

More information

Visit the American Cancer Society for its current cancer screening guidelines.

Posted: October 2009


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