The Washington Post recently reported that men should NOT receive a routine blood test for prostate cancer. A government task force concluded that “for every one man saved by PSA testing, another one will develop a dangerous blood clot, two will have heart attacks and 40 will become impotent or incontinent because of unnecessary treatment.”

Now before you think this is new news, similar information was reported by The New York Times back in 2009 and I first wrote about it when we originally launched New England Health Advisory in 2010. So this week, I am re-visiting the article  I wrote about prostate screening two years ago, as it is every bit as relevant and important today. Next time, I’ll share what you can do to achieve and maintain a healthy prostate, whether you opt for testing or not.

For the ladies, I am fairly sure there is someone in your life you love and care for who has a prostate, so this information is important for you as well. But to make it even more relevant, I added some information about breast cancer screening that you’ll want to consider as well.

Prostate Screening

In March 2009, the New York Times ran a story with the headline, “Prostate Test Found to Save Few Lives.” The article reported on two large studies, one in the US and one in Europe, indicating that the prostate-specific antigen (PSA) blood test that screens for prostate cancer was shown to save few lives — and that it led to risky and unnecessary treatments for large numbers of men.

The Chief Medical Officer of the American Cancer Society, Dr. Otis Brawley, called the studies “some of the most important studies in the history of men’s health.”  Experts have been debating the value of the test for years and the cancer society has long been urging men to be fully informed before they decide to have a PSA test, but they never had the data to back it up. “Now,” as Dr. Brawley states, “ we actually have something to inform them with,” Dr. Brawley said. “We’ve got numbers.”

The New England Journal of Medicine published both study reports the same day. The European study covered 182,000 men in seven European countries and the US study — conducted by the National Cancer Institute — included nearly 77,000 men at 10 different medical centers across the U.S.

In both studies, participants were randomly selected to either be screened by the PSA test or not and then they were followed for a decade afterward. Prostate cancer deaths were tracked among each group in order to determine if the screening made any difference to prostate cancer mortalities.

In the American study, all the men were followed for at least seven years, while most of the men were tracked for ten years. After seven years, the group that had not been screened had a prostate cancer death rate 13% lower than the screened group.

The European study was more complex and included several studies with different designs. But taken together, they found that there was a 20% reduction in deaths in the screened group, but that the number of lives saved over the nine year follow up was very small: 7 lives for every 10,000 men screened. There was no benefit found in the first seven years after screening.

When the test was undertaken, some urologists said it was unethical not to screen men and demanded it be shut down. Many scientists expected to see some difference in mortality rates as soon as five years into the study. But that did not occur. Some experts were thrilled to see the data confirming what they’d suspected all along.

The PSA test that is conducted indicates whether there is a possibility that cancer might be present. This then leads to biopsies in order to determine if there is a tumor. But even if there is a tumor, not all tumors lead to death: many grow very slowly and are never a threat. Those that do grow quickly, often grow so fast that early detection might even be too late.

While no benefit to screening was found in the US study, a small benefit was found in the European study. But in the European study, 48 men were told they had prostate cancer and treated needlessly for every one man that was saved within the decade after the PSA test.

Dr. Peter B. Bach of Memorial Sloan-Kettering Cancer Center put it this way, “One way to think of the data is to suppose he has a PSA test today. It leads to a biopsy that reveals he has prostate cancer, and he is treated for it. There is a one in 50 chance that, in 2019 or later, he will be spared death from a cancer that would otherwise have killed him. And there is a 49 in 50 chance that he will have been treated unnecessarily for a cancer that was never a threat to his life.”

Treatment for prostate cancer is not without impact: it can result in impotence and incontinence if the treatment option is surgery and chronic diarrhea or painful defecation when treated with radiation.

Dr Michael Barry of Massachusetts General Hospital wrote an accompanying editorial pointing out that if the European study is correct, mammography has comparable benefits to prostate screening. About 10 women receive diagnosis and treatment for breast cancer as a result of a mammography for every one death that is prevented.

The real screening benefit would come from a test that could determine which tumors are cancerous and which are not, but that test does not yet exist.

In the year since the release of the studies, the cancer society has tried to spread the word about these test results, and in March of this year it revised its screening guidelines to recommend that “beginning at age 50, men with no special risk of prostate cancer discuss the pros and cons of screening with their doctors and decide together whether it’s worth doing.”

“What we are trying to say to men is the harms (of prostate screening) are better proven than the benefits,” said Dr. Otis Brawley, chief medical officer of the American Cancer Society. The new guidelines are not really that different from those that have been issued previously in 1997 and 2001, but they now come with an increased focus on individual counseling.

The American Society of Clinical Oncology, representing the cancer specialists including those who treat prostate cancer patients, supports the Cancer Society Guidelines.

“All men considering testing for prostate cancer should be fully informed by their clinicians about their risk factors and other uncertainties before being screened,” a statement from ASCO President Dr. Douglas Blaney said.

The American Urological Association does not fully agree. They agree that informed decision making is important, but they think men should have a baseline PSA test at age 40 and then annually after 50. They say that everyone should get the screening and rather than discussing the risks and benefits of screening prior to screening, the discussion should wait until the 10-15% of men whose screening results indicate a risk of cancer and then should be advised of the risks and benefits of treatment.

Everyone agrees an informed discussion should take place: the question they disagree on is should it happen prior to having a screening or after you get the potentially “bad news” results and assess your treatment options.

One argument made is primary care physicians don’t have the time (or sometimes all the information) to sit down discuss and advise a patient in their brief physical, when they also need to guide them on issues like diet, exercise, blood pressure, diabetes, and heart health. This is a valid point, to which Dr. Brawley of the Cancer Society responded that the new guidelines state that men can “be referred to reliable and culturally appropriate sources” for their counseling on whether or not to have a PSA screening, so “the information doesn’t have to come from a doctor.”

Most American men are screened, resulting in a diagnosis of prostate cancer in an estimated 192,000 men last year. In Europe, most men are not screened. The decision regarding whether or not to screen is a personal one based on your own health history, diet, lifestyle and genetic predisposition and it should be discussed with your doctor. But you should be informed fully as to risks and benefits of such a screening and should be aware of the guidelines put forth by the American Cancer Society and the American Society of Clinical Oncology so that you can partner with your doctor to make an informed decision.

Breast Screening

And for the ladies, similar questions are raised regarding breast screening and mammograms. Mammograms use radiation to detect lumps in the breast and are touted as an early screening mechanism. However, many experts have stated that it can take as long as 7-8 years before a cancerous lump is large enough to be detected by a mammogram.

The job of a mammograms is not to detect cancer: its job is to find lumps. They are not completely reliable, however, as the National Cancer Institute reports that they miss up to 20% of cancers present at screening. They can also yield false positive results. A Swedish study revealed that 70% of the lumps detected by mammograms were not tumors at all. (Which means that that 70% of women endured unnecessary procedures for false positive results.) Now the flip side to that is that 30% were tumors and that mammograms may potentially have saved those women.

But in doing so, the mammogram may also have caused the cancer. The mammogram itself exposes delicate breast tissue to radiation and repeated radiation exposure is linked to cancer. The mammogram breast compression process can also rupture blood vessels, resulting in existing cancer spreading to other areas. In addition, some women also have a gene called oncogene AC, which is extremely sensitive to radiation. One statistic I saw stated that 10,000 women will die from breast cancer this year due to mammography activating this radiation sensitive gene.

According to the National Cancer Institute, “Screening mammography is also associated with potential harms, including false-negative results, false-positive results, the diagnosis and treatment of cancers and ductal carcinoma in situ lesions that would not have caused symptoms or threatened a woman’s life (i.e., overdiagnosis, overtreatment) and radiation exposure.”

So if the risks of mammography concern you, as they do me, what can you do? One alternative is thermography or thermal imaging, which can detect abnormalities years earlier. Pre-cancerous growths need nutrients to grow and the resulting chemical and blood vessel activity raises surface temperatures in the breast. Thermography can detect these changes without radiation or compression, often years before a mammogram would discover a lump.

If you are unsure about whether your potential cancer risk outweighs radiation risks, you might also consider gene testing. In addition the radiation gene already mentioned, there are two gene mutations linked to breast cancer: BRCA1 and BRCA2. According to the Susan G. Komen Breast Cancer Foundation, “A woman’s odds of developing breast cancer in her lifetime (assuming she lives until the age of 85) are a bit over 13 percent if she does not have a BRCA1 or BRCA2 mutation, 60 percent to 80 percent if she has a BRCA1 mutation, and 30 percent to 85 percent if she has a BRCA2 mutation.”

In addition to knowing your family history and your own personal awareness of the presence of excess estrogen levels in your body, clearly, knowing your gene mutation risk would be helpful in guiding your choices. The Canadian Cancer Society has concluded there is no benefit to screening women under the age of 50 by mammogram. In the US, however, health care – especially cancer diagnosis and treatment — is a big business.  Screening recommendations carry enormous financial impacts and aren’t necessarily based on what’s best for YOU. It is up to you to partner proactively with your doctor to determine what your risk profile and tolerance is and determine your best options for breast health.

If you want to read the full Washington Post article just released regarding prostate cancer screening, you can find it at:

To your wellness and health : your true wealth!


Author: Inger Pols is the Editor of the New England Health Advisory and Author/Creator, Finally Make It Happen, the proven process to get what you want. Get a free special report on The Truth About Sugar: It’s Not All Equal at

Photo Source: Microsoft Clip Art

© 2012 Inger Pols, Inc. Suffusion theme by Sayontan Sinha