Human Exceptionalism

Desire to Detect Prostate Cancer Early Disdained as “Religious” Pursuit by American Cancer Society Spokesman

I never cease to be amazed at the sense of superiority that drips from the pores of some people who work in the sciences. I find this quite irritating, which was brought to a head for me this morning when I read a story about prostate cancer screening.

For years, we have been told repeatedly and often to get screening tests for cancer because, logically enough, the earlier you catch the disease the greater the likelihood of surviving. That remains true of cancers such as of the breast–get those mammograms–and the colon–get those colonoscopies. But apparently, research increasingly indicates that this general rule may not necessarily apply to the early detection of prostate cancer.

Whether this is true or not is worthy of reasoned discussion. But catch this looking-down-his-nose comment by a representative of the American Cancer Society about men and doctors who seek to detect prostate cancer early through PSA blood testing. From the story:

“Americans have been getting screened for prostate cancer because there is this religious faith that finding it early and cutting it out saves lives,” said Otis W. Brawley of the American Cancer Society. “We’ve been doing faith-based screening instead of evidence-based screening. These findings should make people realize that it’s a legitimate question about whether we should be screening for prostate cancer.”

Yes it is a legitimate question, but deciding to screen is hardly irrational, which is what Brawley was saying by calling prostate screening a “religious faith.” Indeed, the question has been–and remains–unsettled. For example, last year the Annals of Internal Medicine published this recommendation from the U.S. Preventive Services Task Force about prostate screening:

Current evidence is insufficient to assess the balance of benefits and harms of screening for prostate cancer in men younger than age 75 years (I statement). Do not screen for prostate cancer in men age 75 years or older. [Me: This is because prostate cancer grows so slowly in elderly men that the patient is likely to die from other causes long before the disease becomes life-threatening.]

Whether or not to conduct PSA tests for prostate cancer is a questions men and their doctors should carefully explore. But just because a few studies now show that it may not extend lives doesn’t mean that anyone who elects to get a PSA screening is engaging in an irrational medical practice.


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