post by Bill Gardner
Here is what Newt Gingrich said about prostate cancer screening last night.
...the most recent U.S. government intervention on whether or not to have prostate testing is basically going to kill people. So if you ask me, do I want some Washington bureaucrat to create a class action decision which affects every American's last two years of life, not ever. I think it is a disaster. I think, candidly, Governor Palin got attacked unfairly for describing what would -- would, in fact, be death panels.
And -- and -- what [former Director of the National Cancer Institute] von Eschenbach will tell you if you call him is: The decision to suggest that we not test men for -- with PSA will mean that a number of people who do not have the -- who are susceptible to a very rapid prostate cancer will die unnecessarily.
What is he talking about?
There was a great article in The New York Times Magazine on the difficult decision about whether men should be screened for prostate cancer using the prostate-specific-antigen test (and there is more here). This is a relatively inexpensive, minimally-invasive test that can spot a potentially deadly prostate cancer years earlier than the alternative of manual examination of the prostate. Unfortunately, in my view, the test doesn't work:
six randomized clinical trials that considered whether being screened for prostate cancer reduced overall and cancer-specific mortality in men. Mia Djulbegovic and her colleagues analyzed data on over 350,000 men who participated in experiments where they either were or were not screened. Their stark conclusions:
In this systematic review and meta-analysis of prostate cancer screening we failed to find a significant impact of prostate cancer screening on overall mortality or death from prostate cancer.
The US Preventive Services Task Force (USPSTF) also reviewed the evidence. They concluded,
In summary, PSA-based screening is associated with detection of more prostate cancers; small to no reduction in prostate cancer–specific mortality after about 10 years; and harms related to false-positive test results, subsequent evaluation, and therapy, including overdiagnosis and overtreatment.
This is the "government intervention" that Gingrich is referring to. Except that it is not an intervention, and the Task Force does not make decisions about anyone's treatment. What they do is summarize the evidence. The "decision to suggest that we not test men" claimed by Gingrich is not, so far as I can see, in the text. I think that not getting the test is the rational inference from the evidence, but read the evidence and draw your own conclusions. However, whatever the USPSTF wrote, men have the same right to make their own decision about the test that they had before the USPSTF issued the report.
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