"The problem is, we have a hard time at this point differentiating cancers that are going to hurt someone and cancers that are not going to hurt someone in their lifetimes," said Dr. Jay Brooks, chairman of hematology/oncology at Ochsner Health System in Baton Rouge, La. "I think screening for various cancers is extremely helpful, and I do believe they have made major public health inroads. What we're trying to do is to fine-tune the screening techniques."
The stage of a person's life, not just the stage of the tumor, has to be taken into account, Brooks said.
"For the man in his 50s whose PSA [prostate-specific antigen] level rises abruptly, that's probably significant. But for the man in his 70s or 80s who has other diseases, probably PSA testing is not a good idea," Brooks added. "Same thing with mammography. If a woman is diagnosed in her 20s, that's probably a significant finding. However, if you're 80 and have dementia, that's probably not a good thing to be doing."
The American Cancer Society currently recommends that all women over age 40 get an annual mammogram. Women at high risk should talk with their physicians about an optimal screening plan.
The society also advises that men talk to their doctor about "whether or not prostate cancer early detection testing is right for them," the cancer society statement read. "This recommendation also still stands."
Kathryn Taylor, associate professor in the Cancer Control Program at Georgetown University's Lombardi Comprehensive Cancer Center, said that "we tell men that there's no right or wrong answer [regarding PSA testing] at present, and it really comes down to a personal choice. And the onus, unfortunately, is on them to really educate themselves about the potential benefits as well as the potential harms."
One of those potential harms is overdiagnosis, added Taylor, who develops patient-education materials to inform men about the pros and cons of prostate screening.
According to the JAMA piece, about half of at-risk men now undergo regular PSA tests, while 70 percent of women over the age of 40 said they had recently had a mammogram.
The availability of PSA testing "has nearly doubled the chance that a man will be diagnosed with prostate cancer in his lifetime," wrote the authors of the JAMA paper.
The chance that a woman will be diagnosed with breast cancer sometime in her lifetime has risen from one in 12 in 1980 to one in eight today, the authors stated.
More than 800 women would have to be screened over a period of six years to avert one breast cancer death, the authors of the JAMA paper said.
Visit the American Cancer Society for its current cancer screening guidelines.
SOURCES: Jay Brooks, M.D., chairman of hematology/oncology, Ochsner Health System, Baton Rouge, La.; Len Lichtenfeld, M.D., deputy chief medical officer, American Cancer Society, Atlanta; Kathryn Taylor, Ph.D., associate professor, Cancer Control Program, Georgetown University Lombardi Comprehensive Cancer Center, Washington, D.C.; Oct. 21, 2009, news release, American Cancer Society; Oct. 21, 2009, The New York Times; Oct. 21, 2009, Journal of the American Medical Association