Medicine
Over the past few years, I've been invited to speak twice at Lancaster General Hospital (PA) about studies of the effects of screening for colorectal and prostate cancer. Recognizing the need to further explore the controversies surrounding the evidence for these tests, Dr. Larry Bonchek kindly asked me to write a scientific commentary about these topics for the Journal of Lancaster General Hospital, which he edits. The result was the article "Challenging the Conventional Wisdom on Colorectal and Prostate Cancer Screening," just published in the journal's Fall 2010 issue. You are more than welcome to read the full article online, but here are my bottom-line conclusions for clinicians and patients:
The decision to perform screening for colorectal or prostate cancer can be complex, and should take in account evidence-based recommendations, the implications of recent studies, and patient preferences. In order to give patients accurate information on the benefits and limitations of cancer screening tests, physicians should discard “conventional wisdom” that has not been supported by scientific evidence. To briefly review:
1) Collecting a fecal occult blood sample for screening during the digital rectal examination is not “better than nothing at all.”
2) FOBT and flexible sigmoidoscopy have comparable benefits and fewer harms than screening colonoscopy.
3) Benefits of PSA screening on mortality are likely small to none.
4) Overdiagnosis and overtreatment of PSA-detected prostate cancers cause substantial harms.
- Psa Screening By The Numbers: No Benefits, Many Harms
Previous studies found that two-thirds of men who receive prostate-specific antigen (PSA) screening for prostate cancer didn't have shared decision making with their physicians. If shared decision making occurred at all, patients were more likely...
- We Need To Know More About Psychological Harms Of Screening
Several years ago, a few colleagues and I performed a systematic evidence review to help update the U.S. Preventive Services Task Force's recommendations on screening for prostate cancer. One of our key questions asked about the harms associated with...
- Excessive Use Of Screening Colonoscopy
According to guidelines from multiple expert groups, including those of the American College of Gastroenterology and the U.S. Preventive Services Task Force, the appropriate interval between colonoscopies for colorectal cancer screening is 10 years. But...
- Why Screening For Colorectal Cancer Shouldn't Be A Hard Sell
Breast and prostate cancer screening tests may dominate headlines, but in terms of the quality of the scientific evidence that early detection saves lives, there are no better cancer screening tests than those for colorectal cancer, or cancer of the large...
- Information On Colorectal Cancer Screening
If you’re a man or woman over 50, chances are that you’ve been told about the importance of being checked for cancer of the prostate or breast. Finding some types of cancers at early stages (before they cause symptoms) may increase one’s chances...
Medicine
Challenging conventional clinical wisdom
Over the past few years, I've been invited to speak twice at Lancaster General Hospital (PA) about studies of the effects of screening for colorectal and prostate cancer. Recognizing the need to further explore the controversies surrounding the evidence for these tests, Dr. Larry Bonchek kindly asked me to write a scientific commentary about these topics for the Journal of Lancaster General Hospital, which he edits. The result was the article "Challenging the Conventional Wisdom on Colorectal and Prostate Cancer Screening," just published in the journal's Fall 2010 issue. You are more than welcome to read the full article online, but here are my bottom-line conclusions for clinicians and patients:
The decision to perform screening for colorectal or prostate cancer can be complex, and should take in account evidence-based recommendations, the implications of recent studies, and patient preferences. In order to give patients accurate information on the benefits and limitations of cancer screening tests, physicians should discard “conventional wisdom” that has not been supported by scientific evidence. To briefly review:
1) Collecting a fecal occult blood sample for screening during the digital rectal examination is not “better than nothing at all.”
2) FOBT and flexible sigmoidoscopy have comparable benefits and fewer harms than screening colonoscopy.
3) Benefits of PSA screening on mortality are likely small to none.
4) Overdiagnosis and overtreatment of PSA-detected prostate cancers cause substantial harms.
- Psa Screening By The Numbers: No Benefits, Many Harms
Previous studies found that two-thirds of men who receive prostate-specific antigen (PSA) screening for prostate cancer didn't have shared decision making with their physicians. If shared decision making occurred at all, patients were more likely...
- We Need To Know More About Psychological Harms Of Screening
Several years ago, a few colleagues and I performed a systematic evidence review to help update the U.S. Preventive Services Task Force's recommendations on screening for prostate cancer. One of our key questions asked about the harms associated with...
- Excessive Use Of Screening Colonoscopy
According to guidelines from multiple expert groups, including those of the American College of Gastroenterology and the U.S. Preventive Services Task Force, the appropriate interval between colonoscopies for colorectal cancer screening is 10 years. But...
- Why Screening For Colorectal Cancer Shouldn't Be A Hard Sell
Breast and prostate cancer screening tests may dominate headlines, but in terms of the quality of the scientific evidence that early detection saves lives, there are no better cancer screening tests than those for colorectal cancer, or cancer of the large...
- Information On Colorectal Cancer Screening
If you’re a man or woman over 50, chances are that you’ve been told about the importance of being checked for cancer of the prostate or breast. Finding some types of cancers at early stages (before they cause symptoms) may increase one’s chances...