Forty years ago, my mother-in-law learned from a mammogram at age 57 that she had breast cancer. We immediately sought the best available treatment. She lived for many happy years and enjoyed precious time with her grandchildren. Would she have died sooner without the mammogram? I don’t know. But here’s what I do know from four decades of working to accelerate progress against all life-threatening diseases: No screening test is perfect; well-informed patients consulting with their doctors are better equipped than a government agency to make decisions about their health; there are options other than screening everyone or screening no one; and finally, there’s no comfort in ignorance.
The U.S. Preventive Services Task Force (USPSTF), a panel supported by a congressional mandate, now recommends that healthy men not receive prostate-specific antigen (PSA) tests, which measure a protein in the blood produced by prostate tissue. I agree that the current PSA test is inexact and, in many cases, leads to overtreatment that can have terrible side effects such as incontinence and impotence. However, research supported by the Prostate Cancer Foundationhas led to the development of several new molecular markers that could soon complement or even replace the PSA test. These new tests, now in clinical trials pending approval from the Food and Drug Administration, should greatly improve diagnosis and treatment of prostate cancer. In the meantime, the USPSTF recommendation is a disservice to the majority of men. While it would eliminate some short-term health-care costs, long-term costs of treating metastatic disease would be higher. And some men will die. A recent European study showed that testing reduced deaths significantly among men ages 55 to 69. These relatively younger patients are the ones the recent recommendation would most likely exclude from testing because they more often appear to be healthy.