Map of life expectancy at birth from Global Education Project.

Friday, October 07, 2011

I told you so

In accordance with my wishes (and once again the awesome power of Stayin' Alive to shape the culture is proved), the U.S. Preventive Services Task Force is about to recommend that we knock it off with the prostate cancer screening. The predictable truckloads of excrement are already hitting the fan. If you want to get informed about this issue, there's no better resource, if I do say so myself, than Stayin' Alive, here, here, and here. (The last one was written before the verdict was in on whether there is any mortality benefit from prostate screening. Basically, there isn't.)

There are two outraged constituencies, between which it is essential to distinguish. One is men who consider themselves prostate cancer survivors, often speaking for advocacy groups. They are absolutely convinced that prostate cancer screening saved their lives and ipso facto, if other men are not screened then lives will be lost.

However, it does not follow. What we do know is that they were screened for prostate cancer, they tested positive, they were treated, and they are alive. What we do not know is whether they would be alive if none of the preceding had happened and the answer is, most likely, yes. In fact, based on autopsy findings, about 70% of men over 70 have prostate cancer when they die, and never knew it. These men would very likely have been among them, had they not been screened, and they would also have retained their urinary continence and erectile function.

A few of them would have died of prostate cancer had they not been screened, but more likely, the cancer would have been detected after it became symptomatic and their chances of survival wouldn't have been all that different. And some men who are screened, and undergo treatment as a result, will die sooner than they would have if they weren't treated.

But, men who are so invested in their survivorship and who have dedicated themselves to saving the world from the terrible fate they avoided just aren't going to give that up easily. It's very hard to accept after the fact that such a momentous decision, and the pain and sacrifice it entailed, might have been a mistake. Especially when you are grateful to your doctors and all that. It's just demanding too much cognitive dissonance for them to change their minds.

The second constituency that's howling is of course all those people who make money from prostate cancer screening. Oncologists, radiologists, drug and device companies. No mystery there. Less screening stops the gravy train. All these people will scream and yell but you had best ignore them -- they have an irreducible conflict of interest.

One more piece of good news -- you don't have to let the doctor stick his finger up your ass any more. Just say no. If this causes more guys to show up for appropriate medical care, so much the better.

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