Another screening fraud exposed: PSA tests do more harm than good

Friday, December 31, 2010 by: David Gutierrez, staff writer
Tags: PSA, screening, health news

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(NaturalNews) Health experts are becoming increasingly vocal in warning that prostate cancer screening may often do more harm than good.

Doctors screen for prostate cancer by measuring levels of the prostate specific antigen (PSA), a marker of prostate inflammation. Because inflammation can be caused by other conditions, however, large numbers of men are regularly referred for unnecessary biopsies only to find that they have no cancer.

The real problem, however, lies with the purpose of screening itself. Cancer screening is designed to detect cancers early, so that treatment can begin with the goal of lengthening life. This strategy works well for aggressive cancers with reliable screening tests, such as cervical cancer.

But not only is the PSA test notoriously unreliable, but the vast majority of prostate cancers grow so slowly that most men who develop the disease will die of other causes before ever exhibiting any symptoms, let alone a risk of death. Because there is no way to distinguish a normal case of prostate cancer from a rare, aggressive one in the early phases, most men who receive a cancer diagnosis undergo aggressive therapies such as radiation, surgery or hormone treatment. Impotence and incontinence are only two of the common side effects of these treatments.

That's why two major studies concluded in 2009 that PSA screening provides no benefit to men, but is regularly harmful, and why nearly all public health agencies no longer recommend the test. The founder of the test himself, Richard Ablin, has publicly called it "a hugely expensive public health disaster ... hardly [more accurate] than a coin toss."

"There is no evidence that screening for prostate cancer results in any public health advantage," write Gerald E. Markle and Frances B. McCrea in their book What If Medicine Disappeared?

The U.S. government actively discourages the test for men over the age of 75, yet one in three still get it yearly. According to Centers for Disease Control and Prevention researchers Michael Wilkes and Jerome Hoffman, of the University of California-Davis and the University of Southern California respectively, this occurs because men are not properly warned about the test's risks.

"People need to understand better that many screening tests are double-edged swords" that should be used selectively, not indiscriminately, said Howard Brody of the University of Texas.

Writing in the San Francisco Gate, Wilkes and Hoffman note that ignoring all recommendations, the medical establishment continues to promote regular PSA testing. They point to a recent UC Davis seminar on "men's health" that focused exclusively on encouraging PSA screening starting at age 40.

Some overtesting may be attributed to the fact that urologists make a large part of their income from PSA tests, Wilkes and Hoffman say. Beyond that, however, U.S. culture at large is one that prefers erring on the side of more medical tests, rather than fewer.

Brody notes that people now view public discussions of overtesting as an attempt to take away "something of great value." Politicians have capitalized on this sentiment with rhetoric about "government getting between you and your doctor."

A sense of how truly pervasive over-screening is comes from a recent study, conducted by researchers from the Memorial Sloan-Kettering Cancer Center and published in the Journal of the American Medical Association, which found that among patients with advanced cancer, significant numbers still underwent screening for other cancers. Two percent still got tested for colon cancer, while 6 percent of women got tested for cervical cancer and 9 percent got mammograms. An astonishing fifteen percent of men received prostate cancer screening. Yet the average patient in the study lived only two years after the initial cancer diagnosis.

The study shows "a culture of screening on autopilot," lead author Camelia Sima said.

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