Some readers of this blog will recall that I suffer from what I call “Koman Envy”. Every year when I see a giant pink ribbon hanging from the capitol or pink labels all over the grocery store, I wonder why prostate cancer is not an equal opportunity disease. Nevertheless, there can be little doubt that awareness of prostate cancer, and particularly the conundrum around screening has received more attention than at any time in recent memory.
Thus, it was of considerable interest when I came across this article in the BMJ today that has reanalyzed the efficacy of breast cancer screening. As you can imagine, when a woman has an abnormality on a mammogram, it is not always cancer. But the only way to tell is to do a biopsy. And…sometimes the biopsy will reveal a pre-cancerous condition called DCIS that might never progress to invasive cancer. I presume that all sounds familiar to the prostate cancer family. What this article did was add in the potential harms of treatment and analyze QALY’s (quality adjusted life years) saved by screening. When harm was added into the equations, the value of screening became less clear.
Although there will never be a definitive answer of when/who/if various groups of men should be screened or stop screening, the increasing awareness that it is not such an easy decision is worthwhile as we attempt to make our colleagues and patients more a part of the process rather than the “just do it” approach that has characterized screening programs up to now.