Friday, October 7, 2011

New PSA Test Recommendations the Right Call

Though the Medical-Industrial Complex will doubtless howl like banshees, the recently released draft recommendation by the U.S. Preventive Services Task Force - to the effect that healthy men should not be regularly screened using the PSA test - is the right call. This recommendation is based on the results of five well-controlled clinical trials.

The PSA or "prostate specific antigen" test is routinely given to males 50 years of age or older , and measures a protein that's released by prostate cells. This protein serves as a proxy indicator to detect cancer of the prostate. The problem is that as the popularity of the PSA test has grown, the number of false positives has likewise, leading to a vast amount of unnecessary suffering and discomfort. Indeed, in many cases an elevated PSA may mean nothing more than normal hypertrophy of the prostate gland, experienced by nearly all men after age 60.

The detection of a false positive, meanwhile, sends the person on a hapless round of biopsies and treatments which often end detrimentally. For example, from 1986 through 2005, 1 million men received surgery (radical prostatectomy), radiation therapy or both according to the Preventive Task Force. Of these, 5,000 died soon after surgery and up to 70,000 suffered serious complications. Half had persistent blood in their semen and up to 300,000 or nearly one third of those treated suffered impotence, incontinence or both.

As a result of the frequency of such complications, even Dr. Richard J. Ablin, who developed the PSA, said recently (The Denver Post, 'Panel says Needless Treatments Follow', Oct. 7, p. 1A and 15A):

"The widespread use of this test is a public health disaster".

Another factor complicating the picture is that in nearly 60% of instances the cancer itself - mostly after age 70 - is so slowly growing that the person will almost always die of something else, such as myocardial infarction, or stroke.

Even before the draft release of the Task Force, there was enormous skepticism brewing regarding the cost to benefits ratio for the PSA. Author Shannon Brownlee in her expose book on the Medical Industrial Complex: 'Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer', noted (p. 202):

"The evidence suggests that the PSA is not saving lives, and even if it is, the large numbers of men who are treated unncessarily are paying a terrible price. They're the equivalent of civilian casualties in our war on cancer."

In respect of patient advocacy groups (some of whom took the Task Force to task, and often push for more widespread screening) she notes regarding this push(ibid.):

"This is the power of magical thinking. We all want to believe that early diagnosis of cancer will protect us. That if we dutifully head to the doctor for our yearly screening tests we can avoid disease and thwart even death. And yet, many of the screening tests we imagine will protect us- mammography, colonoscopy, and mroe recently CT scans to screen for lung cancer- sufer from many of the same drawbacks as the PSA test. The only screening test that has been shown to unequivocally decrease mortality is the venerable pap smear.."

This is sobering, but a conclusion with which I fully concur, especially in an era of massive deficits in which health costs are the biggest drivers. If these costs are not contained they will gobble up nearly all the GDP (or the Index for Sustainable Growth) by 2040. We simply can't afford to go that extensive route.

Thus, in this sense, the Task Force recommendation makes eminent sense, and again, it only applies to healthy men. This alone could save us over $400 million a year in unnecessary biospies, surgeries and other costs just for this one cancer.

In an earlier blog I also referenced a TIME special issue on cancer and how the CAT scans were adding to the costs for chemo and other treatments by "accidentally" detecting cancers when the scans were done for another reason. These newly found "accidento-plasms" added up to nearly 16% of all new cancer and were adding something like a billion dollars a year in medical treatement costs.

The end result is that enhanced screening is no boon if it picks up more cancers that will ultimately bankrupt this country if all are treated. In other words, it is simply impossible to at once contain medical costs and treat every cancer found under the Sun, or accidentally in the human body!

In a future blog I will look at a saner way for cancer prevention which begins with controlling the immense and profitable Chemical Industry now polluting the environment with over 80,000 chemicals a year, most of them carcinogens. Until we confront this toxic monster in our midst - another offshoort of Wall Street and its industrial predators - no amount of cancer screeenings or treatments will make a dime's worth of difference.

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