I’ve been in England this week, with intermittent access to the Internet. So I’ve missed the flurry of “clarifications” issued by the American Cancer Society (ACS) during the past 48 hours in response to a New York Times report that the ACS would be revising its website to suggest the benefits of certain types of cancer screenings may have been overstated.
I figured that article (which I posted about on Wednesday) would cause a firestorm. And it has.
The ACS issued a quick response, which stated its current recommendations regarding breast and prostate cancer still stand. (The ACS recommends that women aged 40 and older should have annual mammograms and that younger women at high risk should talk with their physicians about when they should begin screening. Its recommendations for prostate cancer are that men should talk with their physicians to determine if early screening is right for them).
And here’s Len Lichtenfeld, MD, the society’s deputy chief medical officer, who seems to be outright denying what was reported in the Times:
The American Cancer Society is not working on any stealth project to change commentary on our website to emphasize the shortcomings and risks of screening.
The ACS is always reviewing and reevaluating its screening guidelines, he adds.
I could be wrong, but I sense that something bigger than the usual “annual update” of screening guidelines is happening at ACS — and throughout the rest of the medical community. Attitudes toward screening seem to be undergoing a major (and long overdue) risks-vs.-benefits paradigm shift.
For people who like simple, black-and-white options regarding their medical care, these changes are going to be very disconcerting.
But as as Otis Brawley, MD, the society’s chief medical officer (and the ACS expert quoted in the Times article), emphasized in an interview with National Public Radio this week, “simple messages [about screening] are not always possible.”
Here’s an excerpt of what he said:
Cancer is a very complex and complicated disease. The American Cancer Society makes evidence-based cancer screening recommendations, and strives to provide clear messages about cancer screening to patients and doctors. Our guidelines are constantly under review to evaluate them as new evidence becomes available. Simple messages are not always possible, and over-simplifying them can in fact do a disservice to the very people we serve.
We don’t want to over-simplify it by saying mammography is great. We want to say mammography is a tool which in seven studies has been shown to decrease risk of death. We recommend women have mammography even though we do know that a few women are going to be treated needlessly for their breast cancer. And to prevent that from happening in the future, we need research to figure out the cancers that need to be treated versus the cancers that need to be watched.
And that message actually is true in prostate cancer as well. You know, in the United States we used to either radiate or do surgery on 85 to 90 percent of the localized prostate cancers found. There is a paradigm shift in the last year or so where many urologists are saying let’s step back and let’s watch you. Let’s not be aggressive and treat so quickly. …
[W]e in American medicine for 50 to 80 years have been preaching find it early and cut it out. And we need to refine our message. In my mind this is an ethical issue because misleading people is the absolute wrong thing to do in medicine. You really must tell people what you know, what you don’t know, and label it accordingly.