Skip to main content

Prostate cancer screening's false promise

By Otis W. Brawley, Special to CNN
updated 8:58 AM EDT, Tue May 22, 2012
A report offers strong evidence for ending mass prostate cancer screenings, says Dr. Otis W. Brawley.
A report offers strong evidence for ending mass prostate cancer screenings, says Dr. Otis W. Brawley.
STORY HIGHLIGHTS
  • Otis Brawley: New report says prostate cancer screenings do more harm than good
  • He says medical community has long pushed screenings, though benefits unproven
  • He says an industry grew around screening, ignoring considerable associated risk
  • Brawley: Report should end mass screenings, but it will be tough to slow industry

Editor's note: Dr. Otis W. Brawley is chief medical and scientific officer of the American Cancer Society and professor at Emory University. He is the author, with Paul Goldberg, of "How We Do Harm" (St. Martin's Press).

(CNN) -- Should men be routinely screened for prostate cancer? This question has been asked ever since the prostate specific antigen test, or PSA, became widely available more than two decades ago.

Central to this question is another question: Does prostate cancer screening save lives?

Both questions are hard to answer. Screening clearly helps find cancer. But many of the cancers that are diagnosed and treated do not need to be. Left alone, they will not harm the patient. And some cancers go on to cause death despite treatment.

Otis W. Brawley
Otis W. Brawley

The right question really is: Does screening find some cancers that need to be cured and can be cured?

After an exhaustive process, the U.S. Preventive Services Task Force has announced its final recommendation on PSA-based prostate cancer screening. It finds that the known harms of screening outweigh the potential benefits for men who have no cancer symptoms. It notes that all screening studies have demonstrated considerable harms associated with screening, but only one major study found evidence that screening saves lives -- and that study has some internal inconsistencies. It showed screening saves lives in the Netherlands and Sweden, but not in five other European countries. Even the positive parts of that study did not show a considerable increase in lives saved.

New cancer screening guidelines issued
R&B artist talks about prostate cancer

The task force's methods are notable for their scientific rigor. A group of experts in prostate cancer and in evidence appraisal systematically reviewed and reported on all the scientific evidence to date on prostate-cancer screening and treatment. The task force, a second group with expertise in preventive medicine and screening, then considered the review and made a preliminary recommendation. That recommendation was made available for public comment last fall. Those comments were then considered before a final recommendation was made.

Although the task force recommends against routine screening, it does recognize that some men will still want to be screened because of family history or other concerns. The task force vehemently stresses the necessity of informed consent in such cases: Men must be told of the known harms of screening. Hopefully its strong statement will cause physicians and screening advocates to be more cautious about encouraging screening.

Follow @CNNOpinion on Twitter and Facebook.com/cnnopinion.

For years, professional organizations, including the American Cancer Society, the European Association of Urology, the National Comprehensive Cancer Network and even the American Urologic Association, have urged caution and informed decision-making regarding screening. These recommendations have largely been ignored.

Over the past 20 years, many well-meaning people have supported mass screening. Celebrities, athletes, politicians and cancer survivors have endorsed screening. Mass screening is commonly conducted in shopping malls, churches and community centers, at conventions and state fairs and in vans parked in supermarket parking lots.

News: Task force says PSA tests do more harm than good

Hospitals, medical practices, fraternities, politicians, radio and TV stations and even an adult diaper manufacturer have sponsored mass screenings. Men who attend them are rarely informed of the risks of screening and are often promised unproven benefits.

These two decades of mass screening are estimated to have caused more than 1 million American men to receive unnecessary treatment causing numerous common side effects, including radiation-induced bowel injury, urinary incontinence and impotence, and a significant proportion have serious, life-threatening complications.

Mass screening is a lucrative business. I am haunted by a conversation I had in the late 1990s with a marketing executive at a major American hospital who bragged about his "prostate cancer business plan." His hospital conducted free screening at a local mall every September for Prostate Cancer Awareness Month.

He explained that this was not just cheap and effective advertising for his hospital system. It was also a moneymaker. As he explained it, for every 1,000 men over age 50 who were screened at the mall, 145 would have an abnormal screen, and 135 would go to his hospital for evaluation. Fees collected from them would easily cover the cost of the free screening event. About 45 in that group would have cancer; the rest would be false positives.

The marketer had figured out how many men would be treated with surgery, radiation, and hormones. He had estimates of all the money the center would make from treating all 45 cancer cases. He knew how many men would be treated for urinary incontinence, and what his net profit for treating that would be. Amazingly, he even knew how many of the men would want penile prostheses surgically implanted to treat their impotence.

I asked him one question: "How many lives will you save if you screen a thousand men?" He looked at me as if I were a fool, and said, "Don't you know? No one knows if this stuff saves lives. I can't give you a number on that."

He was right. It would not be until 13 years later, in 2010, that a clinical trial would finally be published suggesting that screening saves lives -- and that trial has internal inconsistencies making that suggestion suspect. Indeed, for two decades, mass PSA-based prostate cancer screening was done in this country without direct clinical evidence showing that it was beneficial to patients.

It was, of course, very beneficial to those who offered it.

While I hope that this new recommendation will put an end to mass screening, I am not optimistic. As Upton Sinclair once said, "It is difficult to get a man to understand something, when his salary depends on his not understanding it."

The opinions expressed in this commentary are solely those of Otis W. Brawley.

ADVERTISEMENT
Part of complete coverage on
updated 9:42 PM EST, Fri December 19, 2014
Conservatives know easing the trade embargo with Cuba is good for America. They should just admit it, says Fareed Zakaria.
updated 8:12 PM EST, Fri December 19, 2014
We're a world away from Pakistan in geography, but not in sentiment, writes Donna Brazile.
updated 12:09 PM EST, Fri December 19, 2014
How about a world where we have murderers but no murders? The police still chase down criminals who commit murder, we have trials and justice is handed out...but no one dies.
updated 6:45 PM EST, Thu December 18, 2014
The U.S. must respond to North Korea's alleged hacking of Sony, says Christian Whiton. Failing to do so will only embolden it.
updated 4:34 PM EST, Fri December 19, 2014
President Obama has been flexing his executive muscles lately despite Democrat's losses, writes Gloria Borger
updated 2:51 PM EST, Thu December 18, 2014
Jeff Yang says the film industry's surrender will have lasting implications.
updated 4:13 PM EST, Thu December 18, 2014
Newt Gingrich: No one should underestimate the historic importance of the collapse of American defenses in the Sony Pictures attack.
updated 7:55 AM EST, Wed December 10, 2014
Dean Obeidallah asks how the genuine Stephen Colbert will do, compared to "Stephen Colbert"
updated 12:34 PM EST, Thu December 18, 2014
Some GOP politicians want drug tests for welfare recipients; Eric Liu says bailed-out execs should get equal treatment
updated 8:42 AM EST, Thu December 18, 2014
Louis Perez: Obama introduced a long-absent element of lucidity into U.S. policy on Cuba.
updated 12:40 PM EST, Tue December 16, 2014
The slaughter of more than 130 children by the Pakistani Taliban may prove as pivotal to Pakistan's security policy as the 9/11 attacks were for the U.S., says Peter Bergen.
updated 11:00 AM EST, Wed December 17, 2014
The Internet is an online extension of our own neighborhoods. It's time for us to take their protection just as seriously, says Arun Vishwanath.
updated 4:54 PM EST, Tue December 16, 2014
Gayle Lemmon says we must speak out for the right of children to education -- and peace
updated 5:23 AM EST, Wed December 17, 2014
Russia's economic woes just seem to be getting worse. How will President Vladimir Putin respond? Frida Ghitis gives her take.
updated 1:39 AM EST, Wed December 17, 2014
Australia has generally seen itself as detached from the threat of terrorism. The hostage incident this week may change that, writes Max Barry.
updated 3:20 PM EST, Fri December 12, 2014
Thomas Maier says the trove of letters the Kennedy family has tried to guard from public view gives insight into the Kennedy legacy and the history of era.
updated 9:56 AM EST, Mon December 15, 2014
Will Congress reform the CIA? It's probably best not to expect much from Washington. This is not the 1970s, and the chances for substantive reform are not good.
updated 4:01 PM EST, Mon December 15, 2014
From superstorms to droughts, not a week goes by without a major disruption somewhere in the U.S. But with the right planning, natural disasters don't have to be devastating.
updated 9:53 AM EST, Mon December 15, 2014
Would you rather be sexy or smart? Carol Costello says she hates this dumb question.
updated 5:53 PM EST, Sun December 14, 2014
A story about Pope Francis allegedly saying animals can go to heaven went viral late last week. The problem is that it wasn't true. Heidi Schlumpf looks at the discussion.
updated 10:50 AM EST, Sun December 14, 2014
Democratic leaders should wake up to the reality that the party's path to electoral power runs through the streets, where part of the party's base has been marching for months, says Errol Louis
updated 4:23 PM EST, Sat December 13, 2014
David Gergen: John Brennan deserves a national salute for his efforts to put the report about the CIA in perspective
updated 9:26 AM EST, Fri December 12, 2014
Anwar Sanders says that in some ways, cops and protesters are on the same side
updated 9:39 AM EST, Thu December 11, 2014
A view by Samir Naji, a Yemeni who was accused of serving in Osama bin Laden's security detail and imprisoned for nearly 13 years without charge in Guantanamo Bay
updated 12:38 PM EST, Sun December 14, 2014
S.E. Cupp asks: How much reality do you really want in your escapist TV fare?
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT