Surviving AmericanSurviving
American Medicine
A recent article in the New England Journal of Medicine (http://nej.md/TRTJQ1) has indicated that over 30 years, the number of early stage breast cancers detected has increased dramatically, but the number of advanced stage cancers detected has reduced only slightly. The implication of this article is that woman should not have mammograms as frequently, since there is “over diagnosis” of breast cancer due to mammograms. The same arguments have been made for PSA screening in men for prostate cancer. So should people continue to have mammograms and PSA tests?
The only way to find out if a person has a cancer, and if that cancer is a serious cancer that requires treatment, is to find it early before it has spread (metastasized) to other organs and to treat it effectively. For very low-grade cancer, we have new treatments with much less side effects and toxicity (especially in breast cancer) and can even watch and wait, delaying treatment until cancers begin to show more serious characteristics (in prostate cancer). New molecular testing and results of clinical trials have given physicians insight as to which cancers require more intense treatment to save a patient’s life, and which tumors can be treated with less intense or minimal therapy, with excellent cure rates for patients.
Regardless of this well-publicized paper in the New England Journal of Medicine, patients should follow these tips:
- Continue to have screening tests (mammograms for woman, PSA tests for men) starting at age 40 (or 50) after discussion of risks and benefits with your physician. Your physician can suggest what is the right starting age for you.
- If your physician is uncertain if you should have screening, get a second opinion.
- If a cancer is found at a screening test, get several opinions regarding what type of therapy would be most appropriate for that tumor.
- Discuss the recommendations with all the physicians and with your family and get additional information from other sources (American Cancer Society, or other reputable sources) before making a decision, but make a decision on therapy promptly.
For more information and a more complete description, see Chapter 9 “Preventing Illness” in my new book Surviving American Medicine for advice on second opinions and reliable internet sources for information.
