Should mortality be the only outcome that matters?
Dartmouth’s Gil Welch has a nice op-ed in the LA Times, discussing whether the very small benefit in lives saved from prostate cancer screening (via Schwitzer) is worth the substantial cost of side effects from overtreatment.
When talking about the recent European study finding a very small benefit to screening, Dr. Welch observes that, “Being 50 times more likely to be diagnosed and treated needlessly than being the one man who avoids a prostate cancer death doesn’t strike me as a good gamble. To the extent I have control over my cause of death, avoiding a prostate cancer death isn’t my top priority . . . And death is not the only outcome that matters to me. I place considerable value on not being medicalized and suffering the side effects of treatment any more than I need to.”
Good point.
Recently, the recommendations for cancer screening, specifically for prostate and breast cancer, has been increasingly cloudy. The costs of false positive tests, including the side effects from unnecessary biopsies and procedures, are real. It’s a good thing that the media is finally coming around to recognizing screening’s potential negative impact.
Both sides will passionately argue whether to screen or not, but what’s most important is that doctors need to discuss the very real consequences of either choice.
Related posts:
- Should I get a PSA test for prostate cancer? A new study shows that screening for prostate cancer doesn’t necessarily save lives
- Prostate cancer screening in blacks, and the lack of balanced information
- Prostate cancer screening in men over 75
- Prostate cancer screening and the PSA test
- Op-ed: Not all screening tests lead to early, better treatment
- Who’s not happy with the new prostate cancer screening recommendations?
- PSA screening and the overdiagnosis of prostate cancer
{ 2 comments }
I agree! We should use only the screenings which have proen to be more effective such as colonoscopies for colon cancer. PSA and DREs even over several years have not been able to establish relevance. Yet they are included in screening recommendation by US PTF. That itself pushes us into defensive medicine. How could you argue with an attorney in the court who touts that the USPTF recommends it but you as a physician do not agree with it!!!
Kevin, what an amazingly balanced response and summary of the debate. You leave room for discussion and seem to recognize that there will be some patients for whom the risks of adverse outcomes from potentially unnecessary surgery (or treatment) are acceptable in light of their understanding and fear of prostate cancer.
Cerebrum, I will wait with you for the USPSTF to change their recommendations; they’ve always been pretty close to the fence on this one. I predict they’ll advise a “discuss the pros and cons with your patient” approach within a year.
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