When Cancer Screening Does More Harm than Good

The headline above appears in the Healthland section of Time on January 6, 2012, based on a study from the Journal of the National Cancer Institute published on the same day. The article, and several others on the same subject, report that the new study showed that men who routinely have prostate exams do not have a higher death rate than those who do not. In fact, the articles suggest that the screening can lead to unneeded procedures and adverse effects.

The new study followed 76,000 men at 10 sites nationwide over a period of about 13 years. Half of the men got annual PSA (prostate-specific antigen) tests along with rectal exams during the six years of the study. The other half, called the "community care" group, continued to receive care from their regular doctors without receiving a routine PSA exam. Although doctors did find about 12 percent more cancers in the group that got the regular PSA screening, both groups had about the same numbers of deaths. This showed that detecting the additional cancers did not reduce the death rate from the disease.

Dr. Gerald Andriole, lead author of the study and chief of urologic surgery at Washington University School of Medicine in St. Louis commented, "The finding is along the lines that routine mass screening of men is probably not very beneficial as far as reducing the chance of dying from prostate cancer."

The article reporting on this study notes that the increased number of findings in the men who got regular PSA tests leads to extra procedures that carry their own risks. In a January 6, 2012 ABC Good Morning America article, Dr. David Penson, director of urologic surgery at Vanderbilt University Medical Center noted, "The test is far from perfect, there are many false positives because of other conditions that can elevate PSA levels, such as an enlarged prostate. That can lead to a cascade of events -- prostate biopsies are not comfortable and carry a risk of infection and a small risk of dying."

In a CNN article on the same day, Dr. Andriole summed up his recommendations by saying, "In the case of a man undergoing an annual checkup, I would not recommend that a PSA test be included with other 'routine' blood tests without a specific conversation between the doctor and patient or caregiver and patient about the pros and cons for him, the patients' specific circumstances."