| HeraldNet - Snohomish County's online news source |
 WEDNESDAY, FEBRUARY 10, 2010 3:47 am |
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Nation & World 
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Cancer experts soften stance on screening tests In some cases, very few lives are saved for the number of tests performed. ST. LOUIS — With cancer screenings, more is always better.At least that’s what people have been told for years — get mammograms, Pap smears, colonoscopies and prostate tests as early and often as possible to catch cancer before it spreads. But a new way of thinking has started to take hold that looks at the risks along with the benefits and concludes that universal routine screenings may not always be the best option for improving public health. The chief medical officer of the American Cancer Society, which generally supports screenings, has said he plans to issue an alert soon saying the benefits of some screenings have been exaggerated. This week, two different medical groups relaxed their screening guidelines for breast and cervical cancers. Women only need to be screened for cervical cancer between ages 21 and 65, according to new guidelines from the American College of Obstetricians and Gynecologists. The leading gynecological society said women should receive Pap tests every two years until age 30 and every three years after that, instead of annually. Women were also advised this week in a report from the U.S. Preventive Services Task Force that mammograms are usually unnecessary before age 50. Both recommendations, for women with an average risk for cancer, were based on an analysis of data looking at the benefits of screenings as well as the risks from false positives and unnecessary treatments. “Both these groups said start (screening) later and do it less frequently, recognizing that they could preserve the benefits of screening and reduce some of the harms,” said Dr. Gilbert Welch, author of “Should I Be Tested for Cancer?” and professor at Dartmouth College in Hanover, N.H. “That’s a real sign of some rational thinking that often has been missing in health care, where the presumption is it’s always better to do more.” The debate over screenings was first launched when prostate cancer tests gained popularity in the early 1990s and mass screenings turned up a lot more disease than doctors expected. Subsequent surgery and other treatments for prostate cancer can lead to serious side effects including impotence and incontinence. Doctors have come to realize that many prostate cancers are so slow growing as to never become deadly. “The question is whether (screening) is something at a population level that makes sense to be doing, or if we’re creating more disease than we’re solving,” Welch said. The idea that cancer isn’t always fatal, even without treatment, is also a fairly new concept. In autopsies of men who have died of other causes, prostate cancer was found in half the men older than 50 and two-thirds of men older than 75, according to the New England Journal of Medicine. The U.S. Preventive Services Task Force last year recommended against screenings for men over 75, since they’re more likely to die from another cause. Most other medical organizations in the past 10 years have changed their stance to no longer recommend routine prostate cancer screening. The National Cancer Institute’s position says “to screen men for prostate cancer is controversial because it is not yet known for certain whether this test actually saves lives. Moreover, it is not clear that the benefits of screening outweigh the risks of follow-up diagnostic tests and cancer treatments.” The Pap test is similar to the prostate test because cervical cancer is more often a slow-growing cancer. Most women who die of cervical cancer have received few or no Pap tests. “The tradition of doing a Pap test every year has not been supported by recent scientific evidence,” said a statement from Dr. Alan Waxman, who spearheaded the new guidelines. “A review of the evidence to date shows that screening at less frequent intervals prevents cervical cancer just as well, has decreased costs, and avoids unnecessary interventions that could be harmful.” There are some cancers, namely of the colon and skin, where a general consensus considers universal screening to be worthwhile. Others, like breast cancer, can present a tougher call for doctors and patients. Mammograms prevent one death from breast cancer for every 1,000 women who get screened over 10 years, according to the National Cancer Institute. The British Medical Journal published an article to help people understand the risk in simple terms. It means that if 1,000 women don’t get mammograms, we can expect four of them to end up dying of breast cancer. If all 1,000 women do get regular mammograms, three will still die of breast cancer. No matter the odds, many doctors and patients say any life saved is worth everyone getting the mammograms. “We’re all in agreement that this is not the best tool, but does that mean we should take the next step and not screen at all?” said Dr. Burton Needles, medical director of the cancer center at St. John’s Mercy Medical Center in St. Louis. “Most of us who treat patients with cancer feel that the benefits still outweigh the risks of screening.” |
- Sorry, Hawkeye; M*A*S*H gets bowled over
- Former Whidbey student shot
- County archive software paid for but waiting for set-up
- Ruling expected on Sultan beating statement
- ‘Roadkill’ caucus seeks a voice for centrist Democrats
- Police seek witnesses in two accidents
- PAWS calls out for critter care-givers
- Boeing has a busy test schedule
- Ex-Boeing engineer jailed for espionage
- Morning mystery: What happened to House Bill 3181?
- Lynnwood sets height limit on grass: 8 inches
(10) - State Senate votes to toss I-960's tax-raising hurdle (9)
- School levies in Snohomish County all passing, Marysville bond failing (6)
- A tidy lawn could be law in Lynnwood (4)
- County archive software paid for but waiting for set-up (3)
- Vote on school levies by Tuesday (3)
- Two suspects sought in Everett shooting that injured two (3)
- North Sound Christian girls winning with just six players (2)
- Schools do well in levy elections (2)
- Everett man charged with assault in attempt to circumcise son at home (2)
- Jackson girls outlast Meadowdale owdale
- OBT raises barre in children’s program
- Junior firefighters
- School levies passing
- Mavericks topple Wolfpack
- Get a second look at Second City Feb. 13
- Sports Briefs
- Warriors advance 11 to regional meet
- Arlington's Cascade Valley Hospital celebrates expansion, national award and 100 years of service
- Business Licences Feb. 2010
- Technology tips for launching your own business
- Business Events Feb. 2010
- Tech Talk: No excuse today for going without a Web site
- State already raising fees and rates that restrict business growth
- Some legislators again targeting people’s initiative petition rights
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