By John Ballard
I'll get right to the point.
Routine PSA screening is (again) not recommended.
Cancer screening tests are vastly overused in the United States, with about 40% of Medicare spending on common preventive screenings regarded as medically unnecessary, an iWatch News investigation reveals. Millions of Americans get such tests more frequently than medically recommended or at times when they cannot gain any proven medical benefit, extracting an enormous financial toll on the nation�s health care system. Doctors disregard scientific guidelines out of ignorance, fear of malpractice suits or for financial gain, as patients inundated by medical advertising clamor for extra tests.
This is old news for readers of Newshoggers. When it's a slow news day it never hurts to beat the same old drum in case somebody hasn't heard it yet.
- How to Rein in Medical Costs, RIGHT NOW (August 2009)
- Plain Talk by a Doctor (October 2009)
- PSA Testing is NOT a Test for Prostate Cancer (March 2010)
- Active Surveillance of Prostate Cancer (November 2010)
So guys, read and decide for yourself.
I have decided in advance for the Swedish Option (see that November link).
In my job as a senior caregiver, mostly for other old men, I have changed more disposable underpants than a mother with a toddler. I'm just a layman, but I don't think little kids pee as often as old people who are incontinent. Scanning the main link above, this part caught my eye...
�Screening is about fifty times more likely to ruin your life than it is to save your life,� says Dr. Otis Brawley, chief medical officer of the American Cancer Society, citing the results of one key study.
Yet prostate cancer screening remains a huge industry in the United States. Hospitals can generate enormous profits from them and sometimes offer free screenings to recruit new patients. By offering free tests to just 1,000 patients, a hospital can bill Medicare and insurance companies $4.9 million in follow-up procedures, Brawley said � a figure calculated by previous administrators at an Atlanta hospital where he once worked.
HealthFair, which takes screening vans to corporations and community events, used to advertise its services to hospitals on the Internet, saying: �With patient revenue being down as much as 30% in some specialty physician groups, a partnership . . .can bring tremendous value to you.�
Zero, the Project to End Prostate Cancer, meanwhile, now takes its vans to 60 locations around the country each year, offering free PSA tests � a practice that Brawley believes is unethical. Mass screening programs, he says, �actually deceive men into thinking that screening is better than the science tells us.� Jamie Bearse, Zero�s chief operating officer, said every man receives information about early detection, adding �the American Cancer Society condemns some men to death with its stance on PSA testing today.�
Even Kimberly-Clark, the maker of Depends adult diapers, has launched campaigns to end prostate cancer, donating money to Zero.
Says Brawley: �While it is a question as to whether prostate screening saves lives, it definitely sells diapers.� A Kimberly-Clark spokesman said its campaign�s intent was not to sell diapers. The campaign�s goal was �bringing an end to this terrible disease,� according to a company press release.
Medicare reimburses health care providers large sums for some prostate cancer treatments, paying as much as $40,000 a patient for intensity-modulated radiation therapy. The government insurance program spent an estimated $1 billion in 2008 on this therapy, according to an analysis of Medicare records by The Wall Street Journal .
�I never dreamed that my discovery four decades ago would lead to such a profit-driven public health disaster,� Dr. Ablin wrote in a New York Times op-ed column last year. Eliminating routine PSA screening, he said, �would save billions of dollars and rescue millions of men from unnecessary, debilitating treatments.�
Time permitting, do read the entire iwatch report. Over five thousand words, it covers lots more than PSA testing.
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The test, which ostensibly screens for prostate cancer, is notoriously inaccurate, delivering a high rate of false positives and false negatives. And, men who get these tests have no greater chance of surviving the test than men who don't.
Seventy percent of positive PSA tests are false positives; the patient does not have prostate cancer. Worse, these false positive tests often result in more tests and treatments that then result in impotence and incontinence and in some cases, premature death. According to the chair of the Task Force, "This test cannot tell the difference between cancers that will and will not affect a man during his natural lifetime. We need to find one that does."
Over a twenty year period, about a million men got prostate surgery, radiation, or a combination as a result of a PSA test. Of those, about 5000 died soon after surgery, and from 10,000 to 70,000 suffered serious complications, and 200,000 to 300,000 were incontinent, impotent, or both. The dimension of the problem was starkly illustrated when the test's developer called its widespread use "a public health disaster."
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