When It Comes to Some Cancers, Are You Better Off Not Knowing?

Some early screenings for prostate, breast and cervical cancer might not save lives

It’s Movember and iVillage is celebrating men who grow mustaches to raise money and awareness for men’s health, especially prostate cancer awareness. Last month we celebrated breast cancer awareness. I’m all for awareness, prevention and screenings that save lives. But what if some screenings don’t actually save lives? Recently, there have been controversial recommendations against annual screenings for breast, cervical and prostate cancer.

It gets me wondering: When it comes to some cancers, are we better off not knowing?

Since it’s Movember, let’s look at prostate cancer first. Last month, an influential panel of primary care providers issued a draft report recommending against routine prostate cancer screening in healthy men. The reason? The test causes more harm than benefit in these men, they concluded. The group, members of the U.S. Preventive Service Task Force (USPSTF), combed through clinical trials and studies looking at the prostate-specific antigen (PSA) blood test. Men over 50 are widely given the test during routine physicals, even though prostate cancer doesn’t usually kill until after age 75. The task force found: “Ninety-five percent of men with PSA-detected cancer who are followed for 12 years do not die from that cancer, even in the absence of definitive treatment.”

Meanwhile, according to Gardiner Harris of the New York Times: “From 1986 through 2005, one million men received surgery, radiation therapy or both who would not have been treated without a P.S.A. test … Among them, at least 5,000 died soon after surgery and 10,000 to 70,000 suffered serious complications. Half had persistent blood in their semen, and 200,000 to 300,000 suffered impotence, incontinence or both.” Harris continues, “Not knowing what is going on with one’s prostate may be the best course, since few men live happily with the knowledge that one of their organs is cancerous.”

Perhaps the harshest critique of the test came last year in a Times op-ed by Richard Ablin, the researcher who discovered the prostate-specific antigen in 1970. Ablin, now a research professor of immunobiology and pathology at the University of Arizona College of Medicine and president of the Robert Benjamin Ablin Foundation for Cancer Research, called routine PSA testing a “public health disaster.” Ablin says that in the United States, the test costs at least $3 billion annually, and much of that money comes from Medicare and the Veterans Benefits Administration. But before you assume that the USPSTF, which is appointed by the U.S. Department of Health and Human Services, is trying to pinch pennies at our expense, it’s important to note that the task force does not take cost into account when making its recommendations.

The same group recently advised scaling back on two screenings for women. Last month, it recommended that sexually active women ages 21 to 65 get pap smears only every three years, rather than every year. For women under 21, the screenings were not advised at all, regardless of sexual history. And two years ago, the group recommended against routine mammograms for women ages 40 to 49 who are not at increased risk of breast cancer, and to shift from yearly screenings to every two years in older women.

Both of these cancers strike a personal cord for me. Like so many women, I’ve had an abnormal pap smear that revealed HPV, the virus that causes cervical cancer. And my mother was diagnosed with breast cancer at age 40, after her very first mammogram. She credits that screening -- and my older sister, who encouraged her to get it -- with saving her life.

It’s a powerful sentiment, and one shared by many women treated for breast cancer after a positive mammogram. But it may actually be true only for a small percentage.

In an excellent story on the realities of mammograms, Tara Parker-Pope reported on a new Dartmouth study: “Among the 60 percent of women with breast cancer who detected the disease by screening, only about 3 percent to 13 percent of them were actually helped by the test, the analysis concluded.” That’s because there’s only a small sliver of women who will have a deadly form of breast cancer caught at the right time by a mammogram. It’s also because treatments have advanced. “Of all the women who have a screening test who have breast cancer detected, and eventually survive the cancer, the vast majority would have survived anyway,” Colin Begg, head of the department of epidemiology and biostatistics at Memorial Sloan-Kettering Cancer Center in New York, was quoted as saying.

Unsurprisingly, asking men and women to opt out of available tests for deadly diseases has been met with controversy. Last week, the American Urological Association (AUA) released a statement urging the USPSTF to reconsider its draft recommendations on prostate cancer testing. Echoing feelings likely held by many people, AUA president Sushil Lacy, M.D., said, “Telling men not to get tested for prostate cancer will move us backward, not forward.”

Is it time to consider whether not getting tested will mean a better future for some?

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