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Value of PSA Screening Questioned

Value of PSA Screening Questioned
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Some medical experts ask whether aggressive PSA screening is a good idea. Britain hasn't had an aggressive screening program, yet there's been a drop in prostate-cancer mortality similar to that seen in the U.S. An editorial co-authored by patient advocate Hazel Thornton appears alongside the Barry study. Thornton has received an honorary doctor of science degree for her work to make medical researchers more aware of patient needs. A cancer survivor herself, she questions whether screening is helpful for individual patients.

"As I know from my own experience, when a man goes for a PSA test or a woman for a mammogram, this is a very personal thing," Thornton tells WebMD. "A person applies the result to his or her own health. But a screening program is based on the attempt to produce a fall in mortality for the entire population. These programs don't stress the limitations, risks, or shortcomings of the test itself, or social and financial consequences that accrue from being screened. One goes into screening believing this has got to be a good thing -- after all, the medial profession is offering it to you. But you find it leads you into very tricky waters."

Most men believe that PSA screening will find cancers earlier and that early treatment will save lives, according to another paper in the same issue of the BMJ. Study leader Ann McPherson, MD, is a primary care doctor who also teaches at the University of Oxford, England.

"This is mainly a group of men who have prostate cancer," McPherson says. "They are most vociferous in saying prostate cancer screening should [be provided by U.K. medical services]."

McPherson lets her own patients know that the PSA test is available. But she tells them about the drawbacks as well as the possible benefits.

"First you need to know it is not a terribly good test in many ways," she says. "It is difficult to interpret the test. It certainly doesn't pick up all prostate cancers, so there is a problem with that. More important is that it diagnoses cancers that would never be very important, and you end up having many investigations and surgeries that aren't necessary."

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