Which Cancer Tests Do You Really Need?
Cancer Tests: Perspectives continued...
"A lot of screening is being done by organizations that can profit from it," he says.
"The truth is, certain tests do have some significant benefit, and every test has some limitations," he says. "In the spirit of informed decision-making, people need to understand both the potential for benefit and the potential for harm."
As mentioned, the recommendations on breast cancer screening from Consumer Reports and the American Cancer Society are different, but Brawley calls these differences ''minimal."
"We recommend women in their 40s get a mammogram on an annual basis, but we also recommend those women get information on the limitations," he says.
These include missing some cancers and ordering additional tests when no cancer turns out to be there.
Some doctors took issue with the decision to use the task force recommendations as the basic source.
"I'm disappointed they followed the task force guidelines, because we feel they are inadequate to protect women," says Debra Monticciolo, MD, chair of the American College of Radiology's Quality and Safety Commission and vice chair of radiology at Scott & White Healthcare in Temple, Texas.
"Right now, we can't cure breast cancer, so we really need to find cancers early," she says. Research has found the best way to do that is by yearly mammograms beginning at age 40, she says.
The recommendation to avoid PSA tests refutes evidence that they work, say Dipen Parekh, MD, a professor and chair of urology at the University of Miami Miller School of Medicine's Sylvester Comprehensive Cancer Center.
"There is no question the decline in the incidence of advanced prostate cancer is due in large part to PSA screening," he says.
However, the recommendation for women at low risk for ovarian cancer not to seek screening is a good one, says J. Matt Pearson, MD, assistant professor and a gynecologic oncologist at the University of Miami Miller School of Medicine's Sylvester Comprehensive Cancer Center.
The lifetime risk of ovarian cancer in the general population is low. When you screen for a cancer that is not common, he tells women, "you are more likely to find a benign abnormality that pushes you toward [unneeded] surgery."