Cancer Society Shifts Stance On Screenings

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The American Cancer Society is in the process of reworking its message about screenings for breast and prostate cancers. It says the benefits of timely detection through screening may have been exaggerated. Dr. Martin Solomon, medical director of Brigham and Women's Primary, offers his insight.

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There are new questions about some cancer screening. The American Cancer Society has always pushed for breast and prostate cancer screening and other screenings. Now it says the benefits of timely detection through screening may have been exaggerated. At the same time, a new analysis in the journal of the American Medical Association found that breast and prostate cancer screenings are turning up more low-risk cancers, but the screenings are not significantly reducing the detection of more aggressive or incurable cancers. There understandably might be some confusion about when or how often to test. So for help, we turned to Dr. Martin Solomon. He's the medical director at Brigham and Women's Primary Care in Brookline, Massachusetts. Doctor, welcome back to the program.

Dr. MARTIN SOLOMON (Medical Director, Brigham and Women's Primary Care): Thank you for having me.

NORRIS: Does this new analysis of screening or the Cancer Society's approach change how you might talk to your patients?

Dr. SOLOMON: I don't think so, except to respond to their questions, which will obviously be stimulated by the controversy surrounding this. I think people are going to be reticent to undergo testing if there's doubt about - or at least perceived doubt about how it's going to be interpreted.

NORRIS: Is that troubling for you?

Dr. SOLOMON: No, I think people should question the things that we're going to do. I don't think this report substantially changes things. The problem we have is that there's a lot of cancer out there and there are a lot of people who will not benefit from screening. But there's an equally large number of people who do. And we're just beginning to learn how to decide who's going to benefit best. For example, with BRCA testing now, we can select out women who we know are at much greater risk and will benefit from much more aggressive screening. And as we get closer and closer to having more personalized medicine based on genetic mapping of individual risks, we'll be able to select out populations that will be better off. But until then we have to paint with a broad brush.

NORRIS: If the idea here is that if screening were really more effective, it might turn up more early-stage cancers and less late-stage or incurable cancers because those screenings would have been caught early on, what explains why they're not seeing that?

Dr. SOLOMON: Well, the so-called late-stage, or aggressive cancers, I think that's going to come, I hope, out of more aggressive genetic screening. No matter how we screen, there are always going to be people we find, even when they're very, very early, that no matter what we do they're going to progress. And we don't how to select out those people. There are also those who are going to be selected as pointed out in the study, who in spite of what we found will not really change their outcome. But there's still a large population of people who do benefit from early screening. And until we know how to select out that population, I think we really need to continue to screen everybody.

NORRIS: And won't this complicate decisions about the screenings that are covered under insurance and those that are not, since it raises questions about the benefits of screening?

Dr. SOLOMON: Well, I think the insurance companies will always look for a reason not to cover. So, I'm sure it will raise questions and we're just going to have to fight that. I can't treat patients based on epidemiologic studies that influence populations. I have to treat the individual patient and every individual patient is different.

NORRIS: It seems, though, that it's been a challenge just to get the message out there that people should get screened and to make that part of their health care protocol. And now the suggestion is that maybe that's not something that they absolutely need to do.

Dr. SOLOMON: Well, that's a suggestion. I think it remains to be reviewed in the community. One thing I've avoided doing in the more than 32 years I've been in practice is not change my practice based on one report or one study, but really wait until it's been reviewed in the medical literature. And I think this report is going to be very heavily and intensely reviewed over the next few months.

NORRIS: That was Dr. Martin Solomon. He's a professor of internal medicine at Harvard Medical School and he sees patients at Brigham and Women's Primary Care in Brookline, Massachusetts. Doctor, always good to talk to you. Thank you very much.

Dr. SOLOMON: Thanks for having me.

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