Breast cancer and prostate cancer: Early detection saves lives?
Posted Nov 05 2009 10:00pm
If breast and prostate cancer were detected early, via mammograms and PSA tests, treatment could begin earlier, and lives would be saved – right?
Wrong, according to a recent article in the Journal of the American Medical Association that examined incidence and mortality rates for breast and prostate cancer over the past 20 years. 1
Why? The authors think that we are in a state of “overdiagnosis” – that many slow-growing, non-threatening tumors are being detected and treated; at the same time, the more dangerous and aggressive cancers may be missed because they can grow and become lethal in the time interval between screenings, and by then treatment will not work. Overall, the mortality rates of breast and prostate cancer have not decreased significantly in the past 20 years.
Still, are there sound reasons to skip these screenings altogether? You decide…
Mammograms: Following detection of a tumor, 80% of biopsies are negative, and the risk of false positives is very high in women under 50. 2 This equates to thousands and thousands of unnecessary surgical procedures are performed on women after they have had a suspicious mammogram result. In a recent review, it was estimated that for every 2000 women screened, one will benefit, more than 200 will have a false positive result, and 10 healthy women will be treated unnecessarily. 3 And those women who are treated for cancers earn many chemotherapy-related deaths counterbalancing any life-span enhancements in those treated. 4 PSA tests: About 70% of men who have elevated PSA levels do not actually have cancer. 1 And the side effects of the associated treatments include bowel, urinary, and sexual dysfunction. 5 Additionally, a 9-year study in Sweden showed that men who had undergone endocrine treatment for prostate cancer were at a 20-30% increased risk of cardiovascular diseases and death from myocardial infarction. 6
With both of these tests, detection of low-risk cancers also causes much undue emotional trauma to patients and their families.
(image credit: Samat Jain @Flickr )
The American Cancer Society now advises:
“There are some cancers for which we don’t currently recommend screening, such as prostate cancer, because the benefits are unclear or unproven.” 7
The authors of the JAMA article offer strategies for the scientific and medical communities: to find specific biomarkers that can differentiate high-risk from low-risk cancers, and to target high-risk individuals with preventive treatments.
I offer a strategy to you: Be proactive – reduce your risk of breast and prostate cancer. Practice prevention by maintaining a healthy weight and eating an anti-cancer diet - a high-nutrient diet rich in protective phytochemicals from cruciferous vegetables, leafy greens, and berries, and minimizing or eliminating browned foods, animal products, and refined flour and sugar. Taking sufficient Vitamin D is also important. You can read more about the strong connections between diet and cancer in my article “ Eat for Health – the Anti-Cancer Diet."
1. Esserman L, Shieh Y, Thompson I. JAMA. 2009 Oct 21;302(15):1685-92. Rethinking screening for breast cancer and prostate cancer.
2. Wright CJ, Mueller CB. Screening mammography and public health policy: the need for perspective. Lancet 1995;346(8966(:29-32.
3. Gøtzsche PC, Nielsen M. Screening for breast cancer with mammography. Cochrane Database Syst Rev. 2009 Oct 7;(4):CD001877.
4. Rock E, De Michele. A Nutritional approaches to late toxicities of adjuvant chemotherapy in breast cancer survivors. J Nutr 2003 Nov;133(11 Suppl 1):3785S-3793S.
5. Albertsen PC, Hanley JA, Fine J. 20-year outcomes following conservative management of clinically localized prostate cancer. JAMA 2005;293 (17):2095-2101
6. M. Van Hemelrijck et al. 1BA Increased cardiovascular morbidity and mortality following endocrine treatment for prostate cancer: an analysis in 30,642 men in PCBaSe Sweden. EJC Supplements - September 2009 (Vol. 7, Issue 3, Page 1, DOI: 10.1016/S1359-6349(09)72024-5)