Tests For Men And Women That Cause Huge Troubles – PSA and Mammogram Tests
17 May 2010
It’s been aptly said that, "All would be well if there were no "Buts". Today, 20th century medicine has provided us with many positive advantages. But it’s also given us some minor and few major "Buts". Recently, two separate reports show why it’s so difficult for medical consumers and doctors to make the right decisions due to conflicting evidence.
A recent report in The British Medical Journal contained shocking news. Dr. Richard Ablin states that doctors should stop using the PSA (prostate specific antigen) test to diagnose early prostate cancer. At this point it’s reasonable to ask, "What gives Dr. Ablin the right to make such a dramatic announcement in such a prestigious medical journal?" The answer? He discovered the PSA test!
Dr. Ablin goes on to say that the test is not specific enough for cancer diagnosis. The cut-off point that separates benign from malignant growths is usually set at 4ng/ml. But 80 percent of men with PSA values of 4-10 have non-cancerous growths. Rather, these men have either an enlarged benign prostate, a prostate infection, taken a drug such as ibuprofen or even had sex before the test. The PSA test shows elevated values for 48 hours following ejaculation.
He cites other reasons for his controversial remark. In the event the test definitely proves the elevation is due to cancer, this poses a major problem. The test has no way of knowing whether the malignancy is slow growing and non-life-threatening, pussycat growth, or a raging tiger that kills.
Equally important, Albin says that for one life saved due to PSA screening, 48 men would have to be treated. This leaves 47 men with treatment that may put them in diapers for life due to urinary incontinence, impotence or both.
What triggered Albin’s public outburst? He believes that financial motives, particularly in the U.S., have spurred a tsunami of testing. He goes on to say that the medical community must confront this reality and cease inappropriate use which would save billions of dollars and rescue millions of men from unnecessary and debilitating treatments.
Critics, of course, would say that doctors have to use existing tests until better ones become available. But Albin’s remarks illustrate how tests can get out of hand particularly when dollars are involved. And in the U.S. medicine has become business driven.
The British Medical Journal also had disconcerting news for women. The blunt message, one that this medical journalist has also stressed, is that breast screening programs seem to have no significant effect on mortality from breast cancer.
A further study however, in the British Medical Journal claimed that although screening was not perfect it does save lives. The Cancer Society and other women’s groups also support this thesis. So who are women to believe?
Dr. Cornelia Baines, professor emeritus at the University of Toronto, has always cast doubt on the overall benefits of mammography. For instance, if 2,000 women had regular screening for 10 years this would only save one women from dying of breast cancer. But 10 women would undergo needless treatment due to false positive results. Then consider the emotional turmoil, needless surgery, and wasted funds that this causes. Far from a minor problem.
Today early diagnosis has become so ingrained in our psyche that criticizing mammography is like damning Motherhood and apple pie. Moreover, no one ever stresses that it is totally impossible to diagnose early breast cancer by mammography. How could it, when mammography is a "lump" diagnosis? Since it takes several years to form a lump big enough to be detected by mammography, this provides time for cancer cells to spread. So, it’s not like the Pap test, that can see individual cells. This is a huge diagnostic difference.
Unfortunately one needs the wisdom of Solomon to answer these questions. But at least men and women should be informed of, not only the positive benefits of early diagnosis, but also the negative ones.
Also realize that vested interest and politics play a huge role. For instance, if the government even suggested limiting the use of mammography thousands of angry women would descend on politicians. No politician will take that chance.
