Rethinking Cancer Screening

 

Mark Twain sent a note to the New York Journal in 1897 responding to a story error in which the illness of Mark Twain’s cousin was incorrectly reported as Twain’s death. Twain told the Journal: “The reports of my death are greatly exaggerated.”

Dr. Otis Brawley, chief medical officer of the American Cancer Society told the New York Times on October 21, 2009, “We don’t want people to panic, but I’m admitting that American medicine has overpromised when it comes to screening. The advantages to screening have been exaggerated.”  In other words, the reports of the benefits of screening have been greatly exaggerated.

The recommendations for mammograms and prostate cancer screening have been off target and set against what the evidence suggested for decades.   An article in the October 21, 2009 issue of Journal of the American Medical Association, titled “Rethinking Screening for Breast Cancer and Prostate Cancer”, says so.  Millions of patients have been damaged by the universal and overly enthusiastic recommendations of early detection programs and screenings.   Oops.  The American Cancer Society’s sorry.  Their bad.  Buy you a drink? 

Enough good scientific evidence to stop these screening programs has been readily available for more than 30 years.  In 1976 Pietro M. Gullino presented his findings on the natural history of cancer, showing early detection is really late detection.  Many other researchers have stated that mammography, breast self-examination, PSA and digital rectal exam are really late detection methods and cannot be expected to save lives by catching cancer before it spreads. By the time these methods “catch” a tumor, the likelihood is that it has already metastasized. 

Sadly, as in so many other fields, there is no money to be made in telling the truth and more than $20 billion is spent annually on screening for breast and prostate cancer.  And while the press may have you believing that there has been a massive breakthrough in the literature leading to the guideline changes, the truth is that the evidence has not changed — only now, more people are willing to tell the truth and give up their chunk of the $20 billion screening pie and hundreds of billions more for the tests and treatments that follow.

And Dr. Brawley (chief medical officer of the American Cancer Society) has “never had a PSA and I do not desire one.” He compares prostate screening to the Tuskegee Experiment—research on the natural progression of untreated syphilis performed on black male patients between 1932 and 1972. This study caused serious mistrust by the black community toward public health efforts in the United States, the ripples of which continue to be evident in some areas today.   Ironically, black males are heavily targeted for prostate cancer screening and treatments.  Brawley has further noted that he is aware of twenty-three different organizations of experts in screening around the world who have considered the question and all have chosen not to make the blanket statement that screening saves lives and men should be screened. Most actually recommend men not get the test because it is not proven effective.

So when the United States Preventive Services Task Force (USPSTF) announced changing its guidelines for mammography and no longer recommending routine screening for women between the ages of 40 and 49 Brawley seems to have changed his tune somewhat. “The American Cancer Society continues to recommend annual screening using mammography and clinical breast examination for all women beginning at age 40. When recommendations are based on judgments about the balance of risks and benefits, reasonable experts can look at the same data and reach different conclusions.” Okidokie, spin doctor.  Interesting how his views change once he is on the payroll for the ACS (his anti-screening opinions were published when he was at the NCI).

The benefits of screening and early detection are theoretically possible for prostate and breast cancer.  But as of yet, these benefits are unknown.  What is known are the risks and harms of screening and the resultant unnecessary treatment for millions that lead to morbidity, mortality, breast mutilation or loss of sexual function.

So the ACS is sorry they have mislead you.  I’m sure they promise never to do it again.  In fact, given the extremely strong evidence linking the consumption of animal protein to cancer, the ACS clearly states that people should, “limit intake of processed and red meats”.  Wow!  Strong words, there.  Limit intake?  Whoa.  Let me process that for a while.  Oh, and we are suggested to “choose fish or poultry”.  Right, because they’re plants, right?  “When you eat meat, choose lean cuts.” 

This is a very interesting strategy on the part of the American Cancer Society.  They are already preparing us for the next big apology.  See, in another 15 or 20 years, they are going to report on the evidence which we already know today.  Animal protein increases cancer rates.  They’re so sorry.  Really. They should have told you that sooner, too.  Buy you a drink?

– BLK

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3 Comments

  1. November 17, 2009 at 11:03 pm

    Excellent commentary Dr Kinsler.
    As a practicing chiropractor I find it ironic that the medical profession, which has deemed science and scientific inquiry as sacred, is now deeply threatened by scientific evidence. Across the nation radiologists are decrying the new guidelines as preposterous. Could this anger be related to a potential loss of income? Hmmmm……….

  2. November 18, 2009 at 7:04 am

    I’m sure there are good, decent doctors trying to do their best to prevent cancer in their patients but it does a disservice to the public to give vague, insipid advice like “reduce red meat”. It may be easy to understand but clinically, for cancer rates, there is little difference between red meat, chicken and dairy. The public needs to know so they can make informed choices. There is plenty of evidence but sadly, little money to be made.

  3. Brett L. Kinsler, DC said,

    November 18, 2009 at 7:17 am

    Dr. Ventura, are you implying that any event in healthcare could ignore scientific data in favor of making money? Seriously? I don’t think you could name eight or nine hundred examples off the top of your head.

    Dr. Elliott, a milktoast recommendation like “reduce red meat” is equivalent to a gentle reminder to kindly watch your step. What is required is the screaming through a bullhorn, “Look out for that minefield! You’ll get blown up!” The former recommendation really just serves the person doing the warning and makes them feel less responsible while the latter might actually save a life or two.


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