Cancer Screening

The December 2012 issue of Treatment Guidelines from The Medical Letter will be on cancer screening, which is not a treatment, but could be thought of as the prelude to a treatment. Anyway, we think guidelines on this subject will be helpful to our readers.

We cover screening for 6 different types of cancer: breast, cervix, colorectal, lung, ovary, and prostate. There are all sorts of conundrums, inconsistencies and medical politics in cancer screening, none of which we talk about in our article. For example, some cynical readers may find less-than-noble motivation in the recommendation for early mammography screening by the American College of Radiology and early prostate screening by the American Urological Society. Their suspicion is probably unjustified (I have no backdoor channels into either organization), but there is no such thing as being too cynical.

The American Cancer Society’s recommendation for screening for prostate cancer incorporates the idea that men of a certain age should be told the facts and decide for themselves whether to be screened or not. So when the facts are really difficult to interpret, the studies are unreliable in ways only well-trained epidemiologists can recognize, and the various societies of experts are screaming at each other over their totally different recommendations, we tell the patients to decide. How lame is that?

The US Preventive Services Task Force recommends that women wait until age 50 to begin mammography screening for breast cancer. The other societies all recommend starting at age 40. I took an unscientific poll of the women in our office. Every one of them who is less than 50 years old plans to start at age 40 or has already started. In this case, the USPSTF does not want women to decide for themselves; it wants to tell them what to do about this disease that terrifies them. My unscientific little poll suggests to me that the horse is long gone from the barn on this one.

Even though it’s not strictly about treatment, do you see how exciting this can be? Coming in December. Subscribers, look for it in your mailbox or on our web site (medicalletter.org). Non-subscribers, get on board.

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