When I first came across the controversy surrounding the frequency of screening for a variety of conditions, including breast and prostate cancer, my first thought was that more and earlier screening is obviously better. It's just common sense?we know that catching cancer earlier can increase the chance of curing it. It turns out that it's not quite so simple though.
Studies have found that starting to screen for cancer too early can increase the risk of false positive diagnoses, which some regulatory bodies argue do more harm than good for the patient. Combined with the emotional hit, these patients would likely undergo more screening and potential biopsies, only to discover that the initial screening was wrong. Additionally, overdiagnosis is a major concern. Screening may find cancers that would never impact a patient's life span or quality of life; however, if these patients know they have cancer, they will likely undergo aggressive treatment regimens to cure it (who can blame them). As we all know, these treatments can take a major toll on your body, as well as your emotional well-being.
As a result, regulatory bodies tend to caution against overzealous screening, and this has been a particular concern in the US. For breast cancer, the US Preventive Services Task Force (USPSTF)
has recently recommended screening should start for women at age 50 instead of 40, unless the women are at otherwise a high risk of developing cancer. In May 2012, the USPSTF recommended against yearly PSA testing
for prostate cancer for men over 50. In general, these decisions are based on findings that the screenings provide minimal benefit in terms of preventing mortality, and that patients may be unnecessarily exposed to the potential harms of treatment.
We?ve touched on this topic before because controversy surrounding screening has been a hot topic for awhile. Despite some regulatory bodies recommending reducing the frequency of screening, doctors continue to lobby for it?loudly. The American College of Radiology, the Society of Breast Imaging, and the American College of Obstetricians and Gynecologists (among others) have all published statements
recommending that women begin undergoing annual mammograms at the age of 40. The American Urological Association
continues to advocate that prostate cancer screening saves lives. Patient groups have also advocated that patients should be allowed to choose to undergo screening if they want.
Cancer isn?t a topic that comes up too much in medtech just because it's not frequently treated with devices. The controversy surrounding screening has, however, impacted medtech to some extent. The amount of breast cancer screening being done can impact wear and tear on mammography machines and other equipment used for diagnosis, such as breast biopsy devices. For prostate cancer, less frequent screening means that fewer men are undergoing treatment regimens, which negatively affects prostatectomy volumes and also impacts the market for brachytherapy seeds and cryoablation devices.
From a patient's perspective, one thing that none of these articles have mentioned is how a negative result after a screening could also greatly positively influence a patient's peace of mind, which is a big positive for screening in my mind. However, like this article says
, patients need to be informed of the potential risks of undergoing screening so that they can make the best decision for them.