New studies suggesting less frequent screening for breast or prostate cancer are revealing divisions among doctors and epidemiologists. One camp recommends yearly screening to detect cancers in their earliest stages. The other suggests that screening too frequently increases false positives, and can lead to more harmful interventions than required. We discuss the variables.

Susan Kutner, chair of Kaiser Permanente Northern California's Breast Care Task Force and chair of The Interregional Breast Care Leaders Group
Jeff Belkora, assistant professor in the Department of Surgery & Institute for Health Policy Studies and director of the Decision Services Unit, Breast Care Center at UCSF
Mark Gonzalgo, associate professor of urology at the Stanford School of Medicine
Richard Knox, Science Desk correspondent for NPR

  • Marc

    There was a $20 million study on Thermography for early breast cancer at Univ Calif Norris Cancer Center saying that it was 99% effective as a negative predictive value=if anything in medicine is 99% effective and is not invasive why is it not used more commonly?  Also it is really effective on dense breast tissue that is not as well screened by mamograms.

  • Ujch

    Interesting, and actually unfortunate, you chose not to include as a panel member a specialist in screening, namely the primary care physician. 

    In our resident internal medicine clinic yesterday at Stanford University, this issues was extensively discussed. One interesting point is the differences we have observed over the years between recommendations of specialty groups (oncology, urology, surgery) versus those that are more inclusive of primary care and screening specialists – despite looking at exactly the same evidence. The former groups tend to recommend more frequent and more widespread use of screening. Why they differ is poorly understood. One hypothesis could be that primary care physicians are more likely to have to work with patients struggling with the long-term complications of treatments for false positives. The opinion was expressed that perhaps what really happened is the USPSTF started increasing the influence of primary care physicians in these decisions, and letting their voices make a difference.

  • SF94116

    I went to my PCP for possible bladder infection, but urine test showed no infection. PCP also did a PSA test which was high at 4.3. Referred me to a urologist who wouldn’t talk to me by phone but only wanted to do prostate biopsy. Did research and concluded my problem could be a prostate infection. Seconds before the biopsy was to start I had my first chance to speak to the urologist. Instead of the biopsy I was prescribed an anti-biotic and repeated the PSA a few weeks later and was down to 2.2.   In 2009 and 2011 I had the PSA and now it is down to 1.5.

  • Heller Aaron

    I think the major problem in our society is that we’re afraid of death. We all have to die, in the end, and trying to “cheat the reaper” will lead to the bankrupting of our society, both monetarily, and spiritually.

  • Jay Galvin

    Where are the statistics that patients can use and consider their own risk?

    For example, after a PSA score of 7.5 my GP sent me to a urologist who did a biopsy and came up with a Gleeson score of 6.  The advice: active surveillance.    

    I’m OK with that, but I’m concerned about the statistical training of most people in the medical industry.

    – They rely on survivability tables from a twenty year Swedish study during which advances in medication, radiology and robotic operation occurred.  American patients are not so homogenous, found so early and maybe more aggressive in their treatment

    – Statistics on incontinence and complications don’t take into account the factors such as efficacy of the treatment program, experience of the surgeon, age and Gleeson score of the patient.

    – One last example, 430,000 new prostate diagnosis per year, 36,000 deaths……  but what were the age of discovery and Gleeson scores of those who did  eventually die?

    Where can we get the statistics?   Even the site has disappointing information, it covers only invasive stats, I think that means metastasized cancer… how does that help an early found Gleeson score?



  • Jeff

    Excuse me, I just tuned in to the show. 

    Wasn’t the study of other societies, with little or no cancers, the trend toward the prevention of cancers?

  • Sam

    While we can have sympathy for individuals such as the recently diagnosed caller, we can’t let individual stories cloud our judgement.

  • guest

    On the positive side for routine screening, a high PSA result detected prostate cancer in my father in his mid-50s who was given radiotherapy at the time.  Unfortunately he is now suffering from advanced metastatic prostate cancer but detecting the cancer though routine PSA screening and receiving treatment provided him with a dozen+ years  of life which he may not have otherwise had.  I am biological scientist and know not all prostate cancers are the same and while the majority are slow growing some do occur earlier in life and can be aggressive.  It is a difficult and personal decision to make with respect to be screened or not and I agree with your speakers that knowledge of what comes next after screening is crucial in making this decision.

  • Jeff

    With a positive detection, dosen’t the patient get a second opinion?

  • Sam

    “If we can even save one life …”

    A very facile and specious argument. Surely the proponents of testing can do better than that.

  • baumgrenze

    My ears heard the ‘lifetime exposure to X-Rays” comment. As a someone born in 1940, I remember a dentist holding film behind my teeth while he took dental x-rays. I do not doubt that the power of the x-ray tube for those images was a significant multiple of those now in use. I remember fluoroscopes in the shoe store and the fun we children had running in and looking at our toes in our shoes until someone on the sales staff chased us out. I remember a naked Crookes’ tube being fired up in physics class (and after class for those interested.) Has anyone interested in the ‘cancer epidemic’ of the 20th century attempted to plot the x-ray exposure of the public?


  • Marc

    Thermography has been approved as an adjunct to mammography and is non invasive (ie.physically or no radiation) and if more studies were done it might prove more effective than mammograms.  If you look at Blink by Malcom Gladwell where he reminds us that almost two thirds of all positives test are false positives.  If all of those positives where routinely redone with thermography and they show that there is 99% chance that you wouldn’t have breast cancer then there would be no need for as many needle biopsy’s 

    • Sam

      But what are the statistics for thermography AFTER testing positive on the mammogram? There may be few false negatives, but there will certainly be a very high number of real (or false) positives. So we still need to do the calculation as to whether that extra test is worthwhile.

  • Mike

    Isn’t the Free PSA test a significant refinement, removing the ambiguities of BPH or inflammation v.s. cancer?  I haven’t heard any discussion of the benefits of”free PSA” testing in these recent findings

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