Dr. Weeks Comment: If its broke, well then do fix it, but now we know that all cancers are not “broke” and some may best be left along. Many many people die with and not from cancer. Careful assessments and intelligent interventions are required. The screening technology has outstripped our ability to use the knowledge wisely.
JAMA. 2009 Oct 21;302(15):1685-92.
Rethinking screening for breast cancer and prostate cancer.
Esserman L, Shieh Y, Thompson I.
Department of Surgery and Radiology, University of California, San Francisco, San Francisco, CA 94115, USA. laura.esserman@ucsfmedctr.org
After 20 years of screening for breast and prostate cancer, several observations can be made.
First, the incidence of these cancers increased after the introduction of screening but has never returned to prescreening levels.
Second, the increase in the relative fraction of early stage cancers has increased.
Third, the incidence of regional cancers has not decreased at a commensurate rate.
One possible explanation is that screening may be increasing the burden of low-risk cancers without significantly reducing the burden of more aggressively growing cancers and therefore not resulting in the anticipated reduction in cancer mortality.
CONCLUSION
To reduce morbidity and mortality from prostate cancer and breast cancer, new approaches for screening, early detection, and prevention for both diseases should be considered.