For the past 40 years doctors have emphasized the value of routine annual screening to avoid more advanced cancer. However some leading scientists have now vocally opposed routine screening for most cancers.
Among these scientists is world-famous Dr. Deepak Chopra. Ironically he is associated with "Care to Make a Difference" (www.Care2.com), whose senior editor yesterday reviewed why routine annual prostate cancer screening is so important.(See www.care2.com/greenliving/symptoms-of-six-common-cancers.html?e05458ea9260a1354fccd8868a2d181d#comment-196248.)
As I pointed out to the editor in some comments at her website earlier this morning, she is right on-target. However, she needs to know that Dr. Chopra last month published an article which goes counter to her advocacy of screening. ("What's Worse: Health Care or Cancer?", The Chopra Center, July 29, 2009, www.chopra.com/wordsfromdeepak.)
Another screening opponent, with whom I spoke two weeks ago, is pre-eminent oncologist, Dr. Otis Brawling, the American Cancer Society's Chief Medical Officer. During my recent phone conversation with him and in his various publications, he too has disavowed the effectiveness of screening as a means for effectively preventing advanced prostate, lung, and most other cancers. (See Natasha Singer, New York Times, p. 1A, July 16, 2009, posted in www.nytimes.com/2009/07/17/health/17screening.html.)
Among Dr. Brawley's reasons for this surprising stance is that screening for most cancers has not been proven to reduce the number of deaths caused by such diseases.And he adds that PSA screening leads to excessive anxiety despite slow-growing cancers for the vast majority of patients. Worse yet, he argues, patients often go on to demand excessive, costly treatments like surgery, with after-effects like ED and incontinence that can be more onerous than the prostate cancer itself.
The well-meaning thoughts of greatly respected physicians and scientists should not dissuade anyone from promoting screening. Not only can screening save lives, but it will often prevent patients from having to experience excruciating pain in case they end up being among the minority whose cancer metastasizes.
The odds may be in most patients' favor, but in view of scientists' inability to assess which cancer will be aggressive and which won't, why take a chance?
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Comment/Question:
Bury your head in the sand, if you wish but I prefer to know and face the enemy cancer, and not deny its potential to kill me.
I consider Dr. Brawley irresponsible, and the American Cancer Society an enormous disappointment for its fickle and outrageous abandonment of men with prostate cancer. I cannot help but note that ACS objected to the advice to women to quit breast cancer examinations until age 50 but acquiesced to the advice to men to quit testing altogether.Does ACS favor women's lives more than men's?
Phil O.
Rabbi Ed's Response:
As I stated in my blog post to which you've responded, I concur that avoiding PSA screening,- the only quasi-effective biomarker currently available, will leave us in the dark since most prostate cancers are symptom-free.
When I spoke about this last year by phone with Dr. Brawley, the ACS Chief Medical Officer, he was emphatic about the dangers of screening. In response I replied that men have a right and obligation to know what's going on in their bodies, and I added that ignorance is not bliss.
His response?: Screening makes sense only if men are fully informed of the risks and benefits of the various treatment options, and active surveillance is viable for those who want to be checked periodically and not risk more invasive treatment.
He has a point that each man has to decide for himself what's in his best interest, after consulting with his urologist and perhaps seeking some "natural" cures through supplements and vitamins. But since there is no scientific means to assure that an early-stage prostate tumor won't suddenly become more advanced, I myself agree with you that I would not want to avoid screening, nor would I agree to active surveillance for myself, which is why I chose robotic surgery.
Why not avoid the possiblity of overtreatment? Because like most men, I wouldn' t want to end up as a statistic among the minority of American men (3 percent=27,000) who die every year of prostate cancer, - the second leading cause of male cancer death.
For your information when he initiallly disavowed prsotate cancer screening in the media (October 2009), Dr. Brawley also publicly indicated that breast cancer screening was imprecise (false postives and negatives) and therefore not needed, but soon thereafter he retracted, indicating that he meant for those under age 40. It may be that breast cancer is a more complex disease than prostate cancer and requires immediate screening and treatment, but it may be that some political as well as medical considerations were at play in Dr. Brawley's retraction.
--Rabbi Ed
Posted by: | May 13, 2010 at 10:06 PM