How screening for prostate cancer can be a gamble, and why either screening or not has consequences

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.