American Cancer Society Not Changing Screening Guidelines Despite Rumors (Part I)

David Mittleman

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The Chief Medical Officer of the American Cancer Society, Otis Brawley, recently warned against over-screening for prostate and breast cancers. While Brawley stated that he does not want his message to confuse people into thinking that all screening is bad, he did argue that the American Cancer Society may have exaggerated the health benefits of screening.

While Brawley does feel that breast cancer screening is particularly important for women over 50, he finds that over-screening is still troubling. This is particularly true for prostate cancer because many prostate tumors never develop into something dangerous. Furthermore, for patients who receive “false positives” the experience can be devastating and produce great anxiety, at the very least. Moreover, many of these same patients choose to undergo further testing, such as surgical biopsy, which is an invasive procedure. However, Brawley describes over-screening as “not new”—it originally developed in the 1970s.

Nevertheless, since the release of the controversial NY Times article outlining Dr. Brawley’s position, the American Cancer Society has issued a statement clarifying their position on cancer screenings:

• The American Cancer Society stands by its recommendation that women age 40 and older should receive annual mammograms, and women at high risk should talk with their doctors about when screening should begin based on their family history.

• Mammograms work and women should continue to get them. Mammography has helped avert deaths from breast cancer, and we can make more progress against the disease if more women age 40 and older get an annual mammogram. Seven clinical trials tell us that screening with mammography and clinical breast exam do reduce risk of breast cancer death. This test is beneficial in that it saves lives, but it is not perfect. It can miss cancers that need treatment, and in some cases finds disease that does not need treatment. Understanding these limitations will help researchers develop better screening tests.

• The society has, since 1997, recommended that men talk to their doctor and make an informed decision about whether or not prostate cancer early detection testing is right for them. This recommendation also still stands.

• While recent studies indicate the advantages of screening for some cancers have been overstated, there are advantages, especially in the case of breast, colon and cervical cancers.