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 11:30 PM EST, Sun December 28, 2014
Les Abend: Before we reach a conclusion on the outcome of AirAsia Flight QZ8501, it's important to understand that the details are far too limited to draw a parallel to Flight 370
updated 8:27 PM EST, Fri December 26, 2014
The ability to manipulate media and technology has increasingly become a critical strategic resource, says Jeff Yang.
updated 11:17 AM EST, Fri December 26, 2014
Today's politicians should follow Ronald Reagan's advice and invest in science, research and development, Fareed Zakaria says.
updated 8:19 AM EST, Fri December 26, 2014
Artificial intelligence does not need to be malevolent to be catastrophically dangerous to humanity, writes Greg Scoblete.
updated 10:05 AM EST, Fri December 26, 2014
Historian Douglas Brinkley says a showing of Sony's film in Austin helped keep the city weird -- and spotlighted the heroes who stood up for free expression
updated 8:03 AM EST, Fri December 26, 2014
Tanya Odom that by calling only on women at his press conference, the President made clear why women and people of color should be more visible in boardrooms and conferences
updated 6:27 PM EST, Sat December 27, 2014
When oil spills happen, researchers are faced with the difficult choice of whether to use chemical dispersants, authors say
updated 1:33 AM EST, Thu December 25, 2014
Danny Cevallos says the legislature didn't have to get involved in regulating how people greet each other
updated 6:12 PM EST, Tue December 23, 2014
Marc Harrold suggests a way to move forward after the deaths of NYPD officers Wenjian Liu and Rafael Ramos.
updated 8:36 AM EST, Wed December 24, 2014
Simon Moya-Smith says Mah-hi-vist Goodblanket, who was killed by law enforcement officers, deserves justice.
updated 2:14 PM EST, Wed December 24, 2014
Val Lauder says that for 1,700 years, people have been debating when, and how, to celebrate Christmas
updated 3:27 PM EST, Tue December 23, 2014
Raphael Sperry says architects should change their ethics code to ban involvement in designing torture chambers
updated 10:35 PM EST, Tue December 23, 2014
Paul Callan says Sony is right to call for blocking the tweeting of private emails stolen by hackers
updated 7:57 AM EST, Tue December 23, 2014
As Christmas arrives, eyes turn naturally toward Bethlehem. But have we got our history of Christmas right? Jay Parini explores.
updated 11:29 PM EST, Mon December 22, 2014
The late Joe Cocker somehow found himself among the rock 'n' roll aristocracy who showed up in Woodstock to help administer a collective blessing upon a generation.
updated 4:15 PM EST, Tue December 23, 2014
History may not judge Obama kindly on Syria or even Iraq. But for a lame duck president, he seems to have quacking left to do, says Aaron Miller.
updated 1:11 PM EST, Tue December 23, 2014
Terrorism and WMD -- it's easy to understand why these consistently make the headlines. But small arms can be devastating too, says Rachel Stohl.
updated 1:08 PM EST, Mon December 22, 2014
Ever since "Bridge-gate" threatened to derail Chris Christie's chances for 2016, Jeb Bush has been hinting he might run. Julian Zelizer looks at why he could win.
updated 1:53 PM EST, Sat December 20, 2014
New York's decision to ban hydraulic fracturing was more about politics than good environmental policy, argues Jeremy Carl.
updated 3:19 PM EST, Sat December 20, 2014
On perhaps this year's most compelling drama, the credits have yet to roll. But we still need to learn some cyber lessons to protect America, suggest John McCain.
updated 5:39 PM EST, Mon December 22, 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
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT