Tuesday, November 17, 2009

New mammography advice follows PSA changes

News that a federal advisory panel recommends women don't start breast screening until age 50 comes from a government advisory group that changed the recommendations for PSA testing last year.

Just last month the chief medical officer of the American Cancer Society said the advantages of cancer screening had been exaggerated, especially for breast and prostate cancers. He told the New York Times that screening for those diseases had led to overtreating small cancers while missing others that are more deadly.

Now the U.S. Preventative Services Task Force recommends women in their 40s should stop having routine mammograms, relying instead on self-examination.

Although the American Cancer Society doctor gave us a preview of this decision, that group and the American College of Radiology, among others, are officially disputing the recommendation.

Livestrong president Doug Ulman said:
"We must break down the barriers to screening and early detection, not create new ones. We must empower women to be well-informed about their health, not send them conflicting signals."
Fortunately, the decision on whether to get a mammogram is the decision of a woman, advised by her doctor.

One danger mentioned in the New York Times, however, is that insurance companies may one day adjust their coverage of mammograms based on the new recommendations.

Last year, the task force changed the guidelines for prostate cancer screening. It stopped endorsing universal screenings and recommended against them for men over 75 years old.

Generally speaking the American Cancer Society does not support routine testing of prostate cancer. However, the group does recommend that doctors should discuss screening with men who are of average risk for prostate cancer at age 50; earlier for men with close relatives who suffered prostate cancer.

Here's the full language of the American Cancer Society recommendation for prostate cancer screening [it's part of the ACS discussion of early prostate cancer detection]:

The American Cancer Society (ACS) does not support routine testing for prostate cancer at this time. The ACS does believe that health care professionals should discuss the potential benefits and limitations of prostate cancer early detection testing with men before any testing begins. This discussion should include an offer for testing with the prostate-specific antigen (PSA) blood test and digital rectal exam (DRE) yearly, beginning at age 50, to men who are at average risk of prostate cancer and have at least a 10-year life expectancy. Following this discussion, those men who favor testing should be tested. Men should actively take part in this decision by learning about prostate cancer and the pros and cons of early detection and treatment of prostate cancer

This discussion should take place starting at age 45 for men at high risk of developing prostate cancer. This includes African Americans and men who have a first-degree relative (father, brother, or son) diagnosed with prostate cancer at an early age (younger than age 65).

This discussion should take place at age 40 for men at even higher risk (those with several first-degree relatives who had prostate cancer at an early age).

If, after this discussion, a man asks his health care professional to make the decision for him, he should be tested (unless there is a specific reason not to test).

Monday, November 16, 2009

Canada study says watchful waiting can be safe

Men with slow-growing prostate cancer tumors don't necessarily need to rush into surgery or radiation -- treatments that can have severe side effects.

Such is the result of a study performed by the Odette Cancer Centre at Sunnybrook Health Sciences Centre in Toronto.

It finds that "watchful waiting" is a low-risk option for patients with early stage, slow-growing prostate cancers.

Of 450 prostate cancer patients whose tumors were considered slow-growing and non-aggressive, the report found a 97.2 percent survival rate.

After 10 years, the study found that men in the watchful-waiting group were 18 times more likely to die of causes other than prostate cancer, says the CTV news website.

"Watchful waiting" is an active medical program that entails regular PSA screenings and biopsies for men diagnosed with prostate cancer. If this method of surveillance discovers a cancer tumor is becoming larger and more aggressive, a more radical form of treatment is proscribed.

In the Canada study, 30 percent of the patients were reclassified during the study period for surgery or radiation. That still leaves 70 percent who didn't take aggressive action against their cancer tumors early on and survived the term of the study.

Watchful waiting is certainly a viable alternative, especially if the doctors consider it. The side effects of surgery and radiation -- incontinence and erectile dysfunction -- can be long-lasting and sometimes permanent.

That's why it's important to get a second or third opinion of your diagnosis, even if it seems cut and dried.

The report is in the latest issue of the Journal of Clinical Oncology.

Friday, November 13, 2009

"Mary Tyler Moore" writer dies of prostate cancer

Even with all the treatments and cures for prostate cancer, the disease still kills at an alarming rate. In fact, the National Cancer Institute estimates that 27,360 men will die of prostate cancer this year.

One of those is "Mary Tyler Moore" and "Cheers" TV sitcom writer David Lloyd who died Tuesday. He was 75.

Lloyd won an Emmy for his script for the Mary Tyler Moore Show episode entitled "Chuckles Bites the Dust," often considered one of the best TV sitcom scripts ever written. That's the final minutes of the episode above, when the news staff visits the funeral for the TV clown.

After writing jokes for Jack Paar in 1962, Lloyd went on to work on the "The Bob Newhart Show," "Phyllis," "Rhoda," "Lou Grant," and "Taxi."

The family asks that donations be sent to the USC Westside Prostate Cancer Center.

More on Lloyd's work and reactions to his death at the LA Times.