Cancer Group Affirms Course On Screening

So where are we today on the question of screening for cancer?

Well, the American Cancer Society is emphatically saying it's not changing its stance on the risks and benefits of screening, contrary to a front-page story in Wednesday's New York Times that said the group is "quietly working" on changes to its Web site that would emphasize "a real risk of overtreating" breast, prostate and some other cancers.

Putting a point on it, Dr. J. Leonard Lichtenfeld, deputy chief medical officer at the group, wrote on his blog:

The American Cancer Society is not working on any stealth project to change commentary on our website to emphasize the shortcomings and risks of screening. If we are, I would know about it, and I haven't heard anything about such a plan. We don't have to. You see, we already discuss these issues right there in plain view, including on this blog.

 

The ACS isn't saying the evidence for all screening is an open and shut case. Dr. Otis Brawley, the group's chief medical officer, talked with NPR's Steve Inskeep on Thursday's Morning Edition about the uncertainties around tests to look for prostate cancer, in particular.

"I and the American Cancer Society are not against (prostate) screening," Brawley said. "But we're for men knowing there are some questions here as to whether screening is effective and then making a decision that they are comfortable with."

Brawley went on to talk about tests that have been shown to save lives, such as mammography and clinical breast exams for women 50 and older. One-third or more of women who should be getting regular mammograms aren't, he said.

Even so, Brawley argues for a more nuanced approach:

We don't want to oversimplify it by saying mammography is great. We want to say mammography is a tool which in seven studies has been shown to decrease the risk of death. We recommend women have mammography even though we do know a few women are going to be treated needlessly for their breast cancer.

That's where more research is needed—to separate the cancers that should be treated from the ones that should just be watched. "We in American medicine for 50 to 80 years have been preaching find it early and cut it out. And we need to refine our message. In my mind, this is an ethical issue."