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Mammograms and PSA Tests: Yes, We've Reached that Age..

I was reading the newspaper this morning and came across this article suggesting that the P.S.A. blood test, the popular screening test for prostate...

I was reading the newspaper this morning and came across this article suggesting that the P.S.A. blood test, the popular screening test for prostate cancer, saves few if any lives and exposes large numbers of men to risky and unnecessary treatment.

Only a few years ago, my eyes would have glazed over at the very mention of the word “prostate” (and I’d have moved directly onto this very clever and funny op-ed about the vagaries of airport security when you’re a female, Harvard-educated Muslim lawyer).

But the reason that my eyes didn’t glaze over this time was that the article reminded me of my own quite recent – and similar – experience with mammograms. It was two years ago and I’d just moved to the U.K. When I went to my G.P. to inquire about getting my (first) mammogram, I was shocked to discover that mammograms weren’t mandatory for women over forty…of a certain, ahem, age. In fact, routine screenings don’t start until you’re 50 in the U.K., and then occur only every three years (vs. the once a year, beginning-when-you’re-40 recommendation in the U.S.)

At first, like the good, loud opinionated American that I am, I was outraged. “This is ridiculous!” I thought. “Just one more example of where national health care really fails you!” But then I took the added step of going on the computer to see whether I could come up with any research to suggest that either approach was more valid. But I couldn’t find anything conclusive, except a lot of things like this study which suggests that despite more frequent screening in the USA, there are no substantial differences in the rates of detection of large cancers across the two countries (although this, more recent study suggests that breast cancer mortality may be higher in the UK).

Unsure of what to do, I finally broke down and asked a friend of mine who’s a health economist in the United States for guidance, and she asked a friend of hers who conducts research on precisely this issue. This woman said that, in fact, it isn’t entirely clear from the research that you need to screen every year from 40. This was subsequently confirmed by another G.P. in my practice who argued that – as the above article on prostate screening suggests – if you begin screening too early, you get way too many false positives, which not only create more expense, but potentially bad health side effects (i.e. unnecessary cancer treatments that make you ill, etc.)

I’m sure the research is way more nuanced than what I’ve presented here. I’m also rather risk-averse, so I tend to incline towards screening as a general rule. I also know several women who failed to screen for breast cancer until it was too late. We all do.

But I guess what I find fascinating in all of this vis-a-vis adulthood is two-fold. First, how important all this stuff becomes once you hit a certain age, if for no other reason than routine screenings of this sort become…well…routine. And second, how, as we grow up, medicine itself becomes less sacrosanct and more open to questioning. When you’re a kid, you do what the doctor tells you and you accept it as gospel. But as we grow older, we increasingly see that medicine – just like everything else – is a changing, evolving body of expertise with trends and conventional wisdoms and theories, all of which can and will be debunked.

How about you? Where do you fall on the screening issue?

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As a relevant sidebar, let me point those of you who are interested to the following study which also appeared in the New York Times earlier this week and has a similar flavor. It suggests that the best way to deal with life-threatening nut allergies may be exposure to the nut in question, rather than avoidance. I’m the mother of a child with peanut allergies, so I follow this stuff with particular interest.

OK, enough studies for one day!

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  1. John McHugh M.D. March 7, 2010 at 1:48 pm #

    screening is really about finding the “bad one” early. unfortunately for prostate cancer you have check or screen a lot of men to find the type of prostate cancer that will be aggressive. we need better markers or a more sensitive psa. for now i am a screening avocate. if you take the concerns about money out of it and then comply with the wishes of a particular patient, the decision to screen becomes very easy. when it comes to prostate cancer.. think frank zappa….. you dont want to be frank zappa……theprostatedecision.wordpress.com

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