Cancer Society Catches Heat for Breast, Prostate Cancer Screening Criticism

"This recent paper points out the fact that we need to go beyond screening for cancers that are already there, to finding the cause and prevention of breast cancer once and for all," Love said. "Not all cancers are alike. We have focused on the risk factors, chemoprevention, and screening for the 'good cancers' that are hormonally sensitive, and generally postmenopausal, and have not done as much for the more aggressive premenopausal cancers."

The same response – that it's the screening tool, not screening, that is the problem -- was heard from some prostate cancer experts.

"The correct conclusion is that the current screening techniques are inadequate," said Dr. Mauro Ferrari of the University of Texas Medical School at Houston. "PSA tests and mammograms are indeed obsolete."

But even it the screening tools are inadequate, Ferrari faulted Brawley for going public with his concerns.

"The conclusion from the new data that screening is less important than previously thought is a grotesque and ill-informed logical error, which has very grave implications for health care policy and the lives and deaths of all Americans," Ferrari said.

ACS Comes Under Fire for Screenings Stance

Meanwhile, Fran Visco, president of the National Breast Cancer Coalition, appeared to be in agreement with Brawley's thoughts as they appeared in the Times article.

"The National Breast Cancer Coalition has said for over a decade that mammography has serious limitations, has not been shown to reduce mortality in women under 50 and should be a personal decision, not a public health message," Visco said. "The American Cancer Society largely helped create the public's unwarranted obsession with screening, they will have to work very hard to help fix the current situation which, again, they caused.

"It is long overdue that we recognize that we should not be pushing for more mammography, should accept that breast self examinations do not save lives and can result in harm and, rather than try to expand screening into younger and younger ages, we should focus on figuring out which breast cancers will be harmful and how to deal with those," she added.

Dr. Patricia Ganz, director of cancer prevention and control research at UCLA's Jonsson Comprehensive Cancer Center, agreed that the medical community should take a hard look at breast cancer screenings.

"[M]aybe we shouldn't start screening women until they're post-menopausal," she said. "Most of the non-serious pre-cancers and very early, small cancers would probably disappear as hormone levels drop... I think there are too many women with pre-cancers and very early cancers that are being overtreated."

Brawley is, however, not without his supporters. Dr. Daniel Hayes, a breast cancer expert from the University of Michigan, said, "I thought Otis Brawley's comments were very courageous and thoughtful."

Moreover, Hayes pointed out that this "is a sea-change for ACS, which has always promoted screening, with or without supporting data. Otis has induced a new culture into ACS, and he will take heat for it -- so he needs to be quoted accurately and his intent -- to induce evidence-based medicine into ACS guidelines -- needs to be understood, without seriously diluting the beneficial effects that screening does have."

For full discussion of this issue, see full expert commentary at: http://www.medpagetoday.com/HematologyOncology/BreastCancer/16538

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