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Screening for breast and prostate cancer (again)

The current issue of the BMJ has a long article by Klim MacPherson, visiting professor of public health epidemiology at Oxford, on mammography. The article finds that the present situation of screening is unsartisfactory and there is inadequate evidence to reach firm recommendations. "The misplaced propaganda battle seems now to rest on the ratio of the risks of saving a life compared with the risks of diagnosis."

For the individual woman, deciding whether or not to go for screening is difficult. "Arguments that polarise are unhelpful and render women, many with strong preferences, more helpless. For too long they have been misled and confused by too much agenda driven analyses of these data." The article, which is quite long and complex, deserves to be read in its entirety.

If women are likely to be confused by the propanda, men face a possibly even more contentious issue when thinking about screening for prostate cancer. The same issue of the BMJ summarises a paper in Arch Intern Med 2020;170:1256-61 which finds that in the USA most men with low-risk prostate cancer opt for invasive treatments that are likely to do more harm than good. This is largely due to widespread use of screening for prostate specific antigen (PSA). PSA is a poor test for cancer; indeed, as I reported in an earlier post, the discoverer of the antigen says that it should never have been used as a test.

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