Routine screening has been touted as the most effective way to stem cancer deaths, but it may instead put patients in harm’s way, according to American Cancer Society chief medical officer Dr. Otis Brawley. Speaking at a seminar last week, Brawley warned that hospitals recommending regular screening may be looking out for their profits rather than their patients.
His comments were in stark contrast to a press release issued earlier this month, supported by the ACS, which recommended more pervasive routine mammography, calling for annual screening for all women over the age of 40. The recommendation was based on a retrospective study in which researcher concluded that early detection through regular screening is the best way to stem breast cancer mortality.
Brawley maintained that regular screening is mistakenly credited with lowering breast cancer mortality, a trend that he said is due more to effective treatment and patient awareness of symptoms. There have been a lot of mixed messages on the merits and dangers of mammography, with physicians groups alternately warning that fewer screenings could result in missed cancers and that over-screening can lead to unnecessary treatment.
Over-screening concerns also extend to lung and prostate cancers, Brawley said, exposing patients to invasive tests that could have deadly consequences. In a study released by the National Cancer Institute, researchers reported that a quarter of the 53,000 patients screened with low-dose helical computed tomography (spiral CT) were found to have "anomalies," leading to more invasive measures such as lung biopsies and thoracic surgery. Brawley said that invasive screening claimed the lives of 16 patients, 6 of which were found not to have cancer on autopsy.
“When I look at the data, I actually see 5.4 lives saved for every 2 people who had a complication due to an invasive procedure and for every 1 life lost prematurely due to diagnostics,” he said during the seminar.
That pattern also extends to prostate cancer screening, Brawley said, warning that men are too-frequently screened and thus subject to over-detection and over-treatment.
"The American Cancer Society … says that men should be told of the uncertainties, risks and potential benefits associated with prostate cancer screening," he said. "We also came out with a statement against mass screening – that is, screening at the mall or screening at the church."
The U.S. Preventative Services Task Force last year updated its recommendations on prostate-specific antigen (PSA) screening for prostate cancer, creating outrage among some urology groups. The report stated that the agency was not only against PSA screening, but that few lives were actually saved by employing PSA testing and early treatment. The USPSTF added that 80% of positive PSA test results are false-positives, warning that men with such results are more likely to endure further testing, including one or more biopsies, or to undergo risky treatments, such as prostate surgery, which kills 5 out of 1000 men within a month of the procedure.
The Large Urology Group Practice Assn. expressed "outrage" at the USPSTF’s recommendations at the time, warning that "failing to detect cancer early will create a public health catastrophe in 5-10 years." Group officials said that the USPSTF "cherry-picked" data and that the agency held a "preconceived bias against screening." Primary care docs surveyed last year by Johns Hopkins University researchers said they were unlikely to curtail their use of PSA testing based on the USPSTF’s recommendation.
