Cancer prevention better than cancer screening

In the past several days, I've been blogging on the new guidelines issued last week for breast cancer screening (mammograms) and for cervical precancer screening (Pap smears). Basically, in both new sets of guidelines, the task forces raised the age at which routine screenings are started, because they felt that screening in the younger age groups found very few positive (malignant) cases. They reasoned that the small benefits of screening in the younger age groups are outweighed by the adverse affects of screening (false positives, unnecessary diagnostic tests and emotional trauma).

The public response was angry, countering that saving lives, even a small number of lives, is preferable to putting up with the non-life-threatening adverse effects of screening.

I'm sympathetic to both sides of the argument. Maybe there's another viewpoint that might put the debate into perspective.

While cancer screening tests have some value, the most effective way of reducing the cancer death rate is by cancer prevention. There are several drugs that can reduce the incidence of common cancers. Finasteride, for example, has been shown to reduce the incidence of prostate cancer by 30%. Though early studies indicated that finasteride mildly increased the incidence of highly aggressive prostate cancers, subsequent studies have shown that this is simply not the case. About 30,000 men die each year, in the U.S. from prostate cancer. Widespread finasteride use could lower the number of deaths by nearly 10,000 each year.

Finasteride is a drug that is used to reduce BPH (benign prostatic hyperplasia), and to reduce hair loss (under the name Propecia). It has a long history of use, and doctors understand the side-effects of Finasteride. The Merck patent on the use of Finasteride for the treatment of BPH has already expired, and the drug can be obtained as an inexpensive generic.

Ask yourself: "How many men do you know who take Finasteride to prevent prostate cancer?" I'm sure it's a very small number. Yet most women, over the age of 40, have mammographic examinations to detect breast cancer, and are prepared to fight anyone who tries to stop them.

There are a variety of agents that reduce the incidence of cancer. Most people are barely aware that the world-wide cancer death rate can be cut much more effectively with inexpensive anti-cancer agents than with expensive cancer screening tests. Both approaches are very important, but there seems to be a sociological blind-spot for prevention. I discuss this issue at some length in my recently published book, Precancer: The Beginning and the End of Cancer.

- © 2009 Jules Berman, Ph.D., M.D.

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