Avoid Your Doctor - A Healthy Habit for 2012?

If you listen to messages about cancer testing from public health "authorities" the bottom line is obvious: Test early and test often — for breast cancer, with a mammography; for prostate cancer, with a PSA test (prostate specific antigen); for colon cancer with a colonoscopy.

You're told who should be screened — such as every women 40 and over, for breast cancer. You're told when the screening should happen — such as once a year for mammograms. And you're told that cancer screening is one of the best deals going for health and longevity.

But what you're typically not told is the possible danger of being screened for cancer — how visiting your doctor for standard screening can not only cost you money, but also your health and well-being!

The truth is that much of what is touted in medicine as life-saving causes more harm than good. New research shows men getting PSA testing were actually more likely to die of breast cancer — while getting very expensive and toxic tests and therapies because of the test.

Several new scientific papers and recommendations are doing their best to inform the public that medical care is often counterproductive — that a routine visit to your doctor for cancer screening may do more harm than good. This is especially so for PSA testing for prostate cancer and mammograms (though colonoscopies still are a good idea — darn!)

Though there are times that these tests may be warranted in high risk cases, I suspect they are horribly overdone overall. The antidote? Being well informed!

"It's easy to sell screening," wrote Dr. Michael Stefanek, a researcher from Indiana University, in a recent issue of the Journal of the National Cancer Institute. "Just magnify the benefits, minimize the cost, and keep the numbers less than transparent." (By which he means confuse the public about the real benefit of screening.)

The Downsides to Cancer Screening

There are several possible downsides to screening.

Any medical test can generate a "false positive" — a result that says you might have the disease, when in fact you don't. These false positive can lead to more testing … overdiagnosis … and overtreatment, with lots of pain and side effects.

The article by Dr. Stefanek followed a recommendation in October, 2011 from the US Preventive Services Task Force (USPSTF) against routine screening for prostate cancer using the PSA test. In their review of research on PSA testing and prostate cancer, the USPSTF found "there is a moderate or high certainty that the service has no benefit or that the harms outweigh the benefits."

In fact, one of the studies they reviewed showed no reduction of mortality from prostate cancer after 10 years of screening — and risks from prostate cancer therapy that included erectile dysfunction, urinary incontinence, and bowel dysfunction. Men in the screening group were actually slightly more likely to die of prostate cancer!

Bottom line from the USPSTF: "After about 10 years, PSA-based screening results in small or no reduction in prostate-cancer-specific mortality and is associated with harms related to subsequent evaluation and therapies, some of which may be unnecessary."

The main problem with the PSA test: It can't distinguish a slow-growing and probably harmless cancer from a fast-growing and deadly one, leading to unnecessary and aggressive therapies. "So you go from being a guy who feels fine and who is potentially one of the majority who would never have known they had this disease to being a guy who wears adult diapers," said Virginia Moyers, MD, chair of the USPSTF panel.

"The PSA test is hardly more effective than a coin toss," wrote the discoverer of the PSA in the New York Times, calling the test a "hugely expensive public health disaster … The medical community must confront reality and stop the inappropriate use of PSA screening. Doing so would save billions of dollars and rescue millions of men from unnecessary, debilitating treatment."

Bottom line for PSA: If you're a candidate for testosterone replacement therapy (TRT), it's reasonable to do a PSA test, to make sure you don't have preexisting prostate cancer. And it's reasonable to do a PSA test three to twelve months after starting TRT. (Free PSA tests are more specific than the commonly used PSA test, so ask your doctor about that test.) Otherwise, PSA should not be done routinely. Also, be careful to decrease the risk of false positives by not having a PSA test within 24 hours of having a rectal exam or colonoscopy.

But PSA tests aren't the only type of cancer screening that doesn't hold up to scrutiny.

In 2009, the USPSTF recommended against routine mammography to detect breast cancer.

"About 5 in every 1,000 women aged 50 to 59 years will die of breast cancer over the next 10 years," wrote Dr. Stefanek. "Annual screening over those 10 years would reduce that number to about 4 deaths, meaning that 999 women screened for 10 years will have gained nothing, and may have been subject to as many as 50% false-positive tests, unnecessary biopsies, overdiagnosis, and overtreatment for breast cancer."

Bottom line for mammography: A yearly mammography isn't worth it. But if you have a lump, have your doctor conduct a sonogram (ultrasound) and a mammography to check it out. If the lump is new, it is reasonable to wait six weeks to see if it goes away on its own. If it's still there after 6 weeks, biopsy it.

Bottom line for medical testing: In response to the recommendations from the USPSTF, many medical authorities started saying the organization was "anti-screening" and trying to "ration" medicine. I consider this to simply be nonsense.

I'm beginning to suspect that, except perhaps for blood-pressure screening (most pharmacies have free blood-pressure machines), a few cancer screening tests, and diabetes screening, people who feel well may do best staying away from doctors.

You need to get as much health bang for your health buck as you can, rather than being banged around by an industry that, though well meaning, is motivated and trained to scare you. So when considering a medical test or therapy, use your common sense — and save your dollars and cents!

Your car gets a 45,000 mile tune up and system check. You deserve one too!

References

"Uninformed Compliance or Informed Choice? A Needed Shift in Our Approach to Cancer Screening," Stefanek, ME, Journal of the National Cancer Institute, first published online November 21, 2011.

"Screening for prostate cancer: a review of the evidence for the U.S. Preventive services task force," Chou R, Croswell JM, Annals of Internal Medicine, 2011 Dec 6;155(11):762-71. Epub 2011 Oct 7.

"Draft Guidelines Recommend Against PSA Screening: USPSTF Review," Medscape