Doctors Worry Patients Will Drop Screenings

by Michael O'Connor | Omaha World-Herald | 10.22.2009

Many women wouldn't think of skipping their annual mammogram, and men are often persuaded to get screened for prostate cancer.

But the American Cancer Society, which has long been a defender of most cancer screenings, now says the benefits of detecting many cancers, especially breast and prostate, have been overstated.

The cancer society will soon start emphasizing that screening for breast, prostate and certain other cancers can come with a real risk of overtreating many small cancers while missing cancers that are deadly.

Local cancer experts and physicians say they understand the organization's point: Screenings aren't perfect.

But they say people shouldn't get the wrong idea.

“I don't think anybody is saying, ‘Don't get screened,'” said Dr. Charles Enke, chairman of the radiation oncology department at the Nebraska Medical Center and the University of Nebraska Medical Center.

He said the cancer society must be careful how it words its new message about screenings.

“The danger you have is that people who are reluctant to even consider screening in the first place will use that as justification to avoid it altogether,'' he said.

Enke said the cancer society's new message could be confusing because doctors generally advocate for screenings.

Dr. Stephen Lemon of the Methodist Estabrook Cancer Center said that women should not give up their annual mammograms and that men should still talk with their doctors about getting screened for prostate cancer.

Patients should talk with their doctors about the need for screenings and at what age they should have them done, said Dr. Brian Loggie of Creighton University School of Medicine.

Dr. Devin Nickol of the NU Medical Center also said patients must understand the potential risks of getting treated for a cancer that might never have harmed them.

Surgery for prostate cancer, for example, can lead to incontinence and impotence, he said. Chemotherapy can cause hair loss, nausea and increased risk of infections.

Enke said what's needed is more research on better ways for doctors to determine which cancers must be treated aggressively and which can be treated minimally or left alone and observed.

It can be hard for people to accept the idea that some cancers are not dangerous and that some might go away on their own, researchers say.

Lemon said there has been some progress on research to help doctors know how aggressively to treat certain cancers.

A test that became available two years ago can help doctors determine whether a woman should be treated with chemotherapy or with a pill that has less-severe side effects, he said.

The cancer society announced Wednesday it was changing its message about screenings.

“We don't want people to panic,” said Dr. Otis Brawley, chief medical officer of the cancer society. But “the advantages to screening have been exaggerated.”

The change was spurred in part by a new analysis in the Journal of the American Medical Association.

Researchers determined that prostate cancer screening and breast cancer screening are finding cancers that don't need to be found because they would never spread and kill or even be noticed if left alone. That has led to a huge increase in cancer diagnoses because, without screening, those innocuous cancers would go undetected.

At the same time, both screening tests are not making much of a dent in the number of cancers that are deadly.

That might be because the deadly prostate cancers have already spread at the time of screening. And many lethal breast cancers grow so fast they spring up between mammograms.

Copyright Omaha World-Herald 2009