Cancer Society Downplays Early Screenings, Doctors Differ

The American Cancer Society earlier this week says it was shifting its stance on the effectiveness of cancer screenings, particularly those for breast and prostate cancer. Host Michel Martin talks with two oncologists Dr. Leonard Lichtenfeld, the deputy chief medical officer of the American Cancer Society and Dr. Wayne Frederick is a member of the National Medical Association and is an Oncologist and surgeon at Howard University.

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MICHEL MARTIN, host:

I'm Michel Martin, and this is TELL ME MORE from NPR News.

We have two conversations about health today. Later, we'll talk more about the public option. That's the idea of a government sponsored health insurance plan that could compete against private insurers. Polls show the public option is regaining public support, strong majorities now support it. So why are so many conservatives, including Democrats against it? We'll hear from a conservative Democrat, Senator Mary Landrieu of Louisiana, who explains her concerns.

But first, cancer. When to screen for it, whether to screen for it. In recent years, the answer seemed simple enough, early and often. But earlier this week, the New York Times reported that the American Cancer Society, which has long been a staunch defender of most cancer screening, is now saying that "the benefits of detecting many cancers, especially breast and prostate have been overstated," end quote.

After the article was published, the society issued a press release saying that the American Cancer Society stands by its screening guidelines. Women are encouraged to continue getting mammograms. Needless to say, this is very confusing. So, we are going to try to clarify this. So, we've called upon Dr. Len Lichtenfeld, he's deputy chief medical officer of the American Cancer Society. Also, with us is Dr. Wayne Frederick. He's an oncologist, and member of the National Medical Association. He's a surgeon and director of the Howard University Cancer Center. He's here with me in our Washington studio. Dr. Lichtenfeld is with us from Florida. Welcome to you both, thank you for joining us.

Dr. LEN LICHTENFELD (Deputy Chief Medical Officer, American Cancer Society): Pleasure to be with you, Michel.

Dr. WAYNE FREDERICK (Oncologist; Surgeon Director, Howard University Cancer Center): Happy to be here.

MARTIN: So, Dr. Lichtenfeld, let me start with you. Has the Cancer Society shifted its stance on cancer screenings or not?

Dr. LICHTENFELD: Michel, the answer is the Cancer Society has not shifted its stance on screening. And as I wrote in my blog yesterday, I'm trying to figure out where the news is. Mammography has limitations. They've been well recognized. We talk about them. But still based on the evidence, it remains despite its shortcomings, the most effective test to diagnose breast caner early, and it has reduced deaths from that disease.

MARTIN: Your colleague at the American Cancer Society, Dr. Otis Brawley, is quoted in the Times as saying, we don't want people to panic, but I'm admitting that American medicine has overpromised when it comes to screening. The advantages to screening have been exaggerated. What in your view is he trying to tell us?

Dr. LICHTENFELD: Well, I think he's trying to tell you what we've known for a long time, and what we've been saying for a long time. That's what I'm saying. I don't think this is news. If there's a perception out there, and I suspect there is amongst some people, that mammography is perfect. And we're not talking about prostate cancer screening, that's a different topic.

But breast cancer screening, if people think it's perfect, it's not perfect. We know that there are cancers that are diagnosed but would not cause harm. We also know there are cancers we don't find early enough. But what we also know is that the death rates from breast cancer have been dropping for about the past 20 years, and mammography has played a very significant role in that decline in incidents - decline of deaths.

MARTIN: Dr. Frederick, let's bring you into the conversation. Does this conversation concern you, not necessarily our conversation, but this confusion over whether screening is desirable or not, concern you?

Dr. FREDERICK: It's extremely concerning to me, Michel. It's concerning for a couple of reasons. Number one, if you look at the disparities and outcomes for cancers, especially in breast, African-American women are less likely to get breast cancer, however, they're more likely to get it in their premenopausal state. So, I routinely have patients in their 20s and 30s that have breast cancer.

The screening guidelines for mammography don't kick in until you're 40. Some people miss that at 35 and somebody's at high risk. In the community that we serve here in D.C., being the nation's capital, it's unfortunate. In the past 18 months, I've seen 24 patients with fungating breast masses. These are women, who did not have insurance, had a breast mass that they felt, weren't able to access care, had a massive goo(ph) and erupted through the skin.

So, my concern is that as we put this news out and it gets more confusing, we are already fighting an uphill battle in our minority communities to get them to get screening. And now, we put information out that, you know, justifies why they shouldn't go and screen.

Secondly, most of the data has suggested that people who do get screened routinely also do other health types of activities that are very helpful. They're more likely to see their primary care physician regularly. They're more likely to be concerned about their blood pressure. They're going to be more likely to eat well, and (unintelligible) exercise. And therefore, the screening, as part of the overall benefits in terms of overall health, I think are well underestimated, especially in those communities that are adversely affected by some of these diseases.

MARTIN: So you're concerned that people who are just now getting the message that they need to be vigilant about their health, may then get a confusing or counter-message to ignore it. And that all the effort around education that you've been trying to achieve, your concern will be undone.

Dr. FREDERICK: Exactly. And secondly, as I said, there's a significant disparities in the outcome. We have made advances, but still African-American women (unintelligible) are much more likely to die from breast cancer when they get it, which means that we may be dealing with a slightly different disease, a different host, different genetic factors. All of which, I think, the screening plays an important role in us getting to the bottom of it.

MARTIN: If you're just joining us, you're listening to TELL ME MORE from NPR News. I'm speaking with doctors Wayne Frederick and Len Lichtenfeld. And we're talking about this controversy over cancer screening guidelines.

Dr. Lichtenfeld, you're saying you're not sure what the news is. But as I understood it, one of the concerns is that there are small, nonlethal cancers that may be - what's the word I'm looking for - that there may be over-detection, if there is such a thing, or that there may be sort of nonlethal cancers that have been detected, but that more lethal cancers are not. For some reason, there's a concern about misdiagnosis. Is that a concern?

Dr. LICHTENFELD: Well, let's understand that all this started because of an article in the Journal of the American Association. It, in fact, was not new research. It was an opinion article or a commentary article that said we really need to do better in targeting people who really need treatment. And we agree wholeheartedly with that.

And frankly, the article went on to draw some conclusions and make some hypotheticals and theoreticals and so forth about what we could be doing better if we did more research. That's what really started this. The answer is, Michel, that yes, we know, and we're very much aware of that. We know we treat many women to save smaller number of lives. That is the fact. And we do need better research to target those people who will benefit from treatment.

But I'm going to come back to something that Dr. Frederick said, because I want to make something else very clear, the American Cancer Society has devoted a considerable amount of research over the past several years to highlighting and understanding disparities in health care. We have committed not only our research money, but our advertising funds, as well as our commitment to improve access to health care over the past several years. And this is critically important.

We could not agree with Dr. Frederick more that access to care, particularly in the African-American and other underserved communities is critical to improving the health of those committees. We have a tragedy on our hands that we need to address. So, we want to make it also clear that we do believe that mammography is important. It remains the best available test. Could we do better with more research, understanding which cancers are really bad cancers? Yes. But right now, we have to deal with the evidence we have, and the best test we have. And in breast cancer that happens to be mammography.

MARTIN: What about prostate cancer? You're saying that that's a different issue, explain?

Dr. LICHTENFELD: It's a different issue because the research has been done to show that breast cancer screening is effective in saving lives. In prostate cancer, the fact is that started back in the late 1980s, we just now have the first research to show whether or not the PSA test really makes a difference. And quite frankly, the results are mixed at best, and we feel don't necessarily prove that prostate cancer screenings save lives. So we believe that in all communities, health care professionals and their patients have to have a careful discussion about the benefits, risks and harms of PSA testing and prostate cancer treatment.

And if a man, after that discussion, thinks they would wish to go ahead with the testing as they've been informed, that's acceptable. But no one should be under the, we think, the misconception that there's absolute proof that the PSA test significantly reduces deaths from prostate cancer.

MARTIN: Dr. Frederick, you were saying that black women are less likely to get breast cancer, but more likely to die from it and they're also more likely to get it earlier than white women are. What about prostate cancer in African-American men?

Dr. FREDERICK: Well, again, you know, the disparity and the disproportionate effect that some of these diseases have as he just pointed out is enormous. I appreciate the point that the American Cancer Society has been making strides to do that. But again, even in this particular study that came out in a journal and was an opinion article, as a matter of fact, I'm pretty familiar with Dr. Albertson from my time at Yukon. My concern about this is in most of these studies, there's often a disproportionate representation of Caucasians versus African-Americans and with prostate cancer, again, African-Americans fall into high-risk group.

So you have a group of people again who will be getting a recommendation and as he said, I think the discussion is worthwhile. The problem is it's very difficult to get these men to the table. And if we bring them to the table with a mixed message, a message that is not forceful, that is not clear and concise, we are less likely to get them involved in what I think is critical behavior patterns.

There's no doubt in my mind that there are some prostate cancers that are detected very early. They're very small. And, therefore, we probably over-treat those. And I'm willing to accept that. However, I think that again the disparities and the outcomes because of access to care and other social issues, which may have a biological nature have not been elucidated enough to make this clear.

MARTIN: What I'm hearing both of you say is that it is very difficult to have a one-size-fits-all message around health. And Dr. Frederick, I'm going to sort of press you on this point. How then can we talk about these issues in the popular sphere, get the message out to as many people as need to get it, but recognizing that, for genetic reasons, some people are more susceptible to certain circumstances and others for social reasons, and that at these - and some people - maybe different communities need to get different messages. I mean, perhaps that's beyond the scope of our conversation today, but what are your thoughts about that?

Dr. FREDERICK: I don't think it's beyond the scope. I think that's the way it needs to start. I think you're absolutely right. You've pointed out, I think, what needs to be done as a beginning issue. I think we need to recognize that if we can decrease the gap in these outcomes, we will significantly affect both financially - since most people are concerned about the economics of these issues - and from (unintelligible) health-survival issue. I am absolutely convinced that if we close the gaps of how poorly minorities and under-insured and underserved communities do with some of these cancers, we will significantly affect the overall survival and the overall care. And I think we have just turned a blind eye to that unfortunately.

MARTIN: Dr. Wayne Frederick is a member of the National Medical Association. He's an oncologist and a surgeon. He directs the Cancer Center at Howard University and he was kind enough to join us here in our Washington, D.C. studios. We were also joined by Dr. Len Lichtenfeld. He is the deputy chief medical officer of the American Cancer Society and he was kind enough to join us on the phone from Jacksonville, Florida. Doctors, gentlemen, I thank you both so much for speaking with us.

Dr. FREDERICK: Thank you.

Dr. LICHTENFELD: Thank you.

(Soundbite of music)

MARTIN: Just ahead, Megan Williams told police two years ago that a group of white men and women in rural Big Creek West Virginia beach stabbed and sexually assaulted her. Now a new lawyer says none of this was true.

Mr. BYRON L. POTTS (Attorney): She self-inflicted the injury. The only thing that was not self-inflicted was the bruises on her face, and that she got in a fight with the guy that she was seeing in this incident and that he beat her up. But that was prior to this event.

MARTIN: The Megan Williams case, new developments, we'll tell you the latest. That's coming up next on TELL ME MORE from NPR News. I'm Michel Martin.

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