My regular readers know the controversies and challenges posed by prostate cancer. It is very common. Over half the men who die at advanced age of other causes will have prostate cancer on autopsy. It is very slow. From the time that prostate cancer is detectable on biopsy to the time that it causes symptoms or shortens life can be as long as a decade. It is not very lethal. Because it tends to affect older men, most men diagnosed with it tend to die of other causes. Though it does kill t...
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American Cancer Society Revises its Guidelines for Prostate Cancer Screening
About a year ago I reviewed the controversies of prostate cancer screening, especially the conundrum that we still don’t know whether finding prostate cancer early saves any lives. I concluded by citing the US Preventive Services Task Force (USPSTF) recommendations that the evidence is insufficient to recommend for or against screening for prostate cancer in men age 50 to 75. The USPSTF recommends against screening men older than 75 as the evidence suggests that harms outweigh...
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New Mammogram Recommendations Betray Women, Doctors and Science
This week the US Preventive Services Task Force (USPSTF) revised their recommendations for screening mammograms. Their recommendations have ignited much controversy and have weakened the credibility of a formerly objective scientific body.
This post is longer than usual. It deals with an important subject in some detail. For the readers who like to delve into the details and see the data, set this aside for when you can give it some time, follow the links, and check out the articles yourself...
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Should You Have a Pap Smear?
Last week I lamented that we can prevent so few cancers. Cervical cancer screening is one of the success stories of prevention. Regular pap smears can drastically decrease the risk of cervical cancer and makes death from cervical cancer virtually unheard of.
Cervical cancer is a sexually transmitted disease, caused by human pappilomavirus (HPV). Pap smears check for telltale changes in the cervix that happen after HPV infection. Over many years these changes lead to cervical cancer.
But w...
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Proactive or Paranoid? When Vigilance is Valueless
What a better topic for Halloween than fear?
All of us when hearing of a coworker or loved one who has been diagnosed with a life-threatening illness wonder if we could be next. “What if I have lung cancer? Should I get checked out? There must be some tests I can get to make sure I’m OK.” Those who take an active role in staying healthy are confident that they could do more to make sure they don’t get some dreaded disease. Most cancers, after all, are preventable, right? Or at least they ...
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Weight Lifting Helps Breast Cancer Survivors with Lymphedema
One of my goals for these posts is to use individual studies to point out the broader trends they suggest. This week I want to focus on our increasing understanding of the value of exercise after illness or injury. A generation ago a heart attack meant weeks of bed rest in the hospital followed by strict instructions from the doctor to take it easy. The weakened heart couldn’t take much exertion, we thought. Now after a heart attack patients are told to start exercising as soon as they’re ou...
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Folic Acid: Fabulous for Fertile Females, Feckless for Fellows
Folic acid, a vitamin found naturally in green leafy vegetables and legumes, is essential for making the building blocks of DNA. And since copying DNA is an important part of what cells do before they divide, it’s critical for cell division. Developing fetuses have very rapidly dividing cells, so it’s not surprising that folic acid deficiency has been linked to birth defects, specifically brain and spinal cord abnormalities.
To prevent these birth defects, physicians for many...
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Screening for Prostate Cancer May Harm More than Help
About 20 years ago a blood test called prostate specific antigen (PSA) was developed with the hope that it would help in the diagnosis of prostate cancer. Since then, countless healthy men have been tested for prostate cancer with a PSA and a digital rectal exam despite the fact that there has never been convincing evidence that diagnosing prostate cancer saves lives.
The reason for the controversy about prostate cancer screening is that prostate cancer is a very slowly growing cancer which us...
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Everyone March to Your Colonoscopy
I don’t know about you, but whenever I think of March, the first thought that springs to mind is National Colorectal Cancer Awareness Month.
Patients frequently ask me to be tested for whichever cancer they are particularly anxious about. “Is there a test to make sure I don’t have early ovarian cancer?” “Pancreatic cancer?” “Lymphoma?” I have to explain that for healthy people without any symptoms, there is no test that has been proven to find these malignancies early or save lives by findi...
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New Recommendation Against Screening for Prostate Cancer in Men 75 and Older
Two years ago I wrote about the controversy of routine screening for prostate cancer. Screening for prostate cancer is usually done with a blood test called PSA. But whether diagnosing prostate cancer early helps patients is still unknown, and there are many serious complications that result from prostate cancer treatment. That's why in many cases of prostate cancer watchful waiting is a reasonable choice.
The U.S. Preventive Services Task Force recently reviewed the existing evidence for an...
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