Abandoning PSA Screening Could Cost Lives: Study

HealthDay – 1 hr 7 mins ago MONDAY, July 30 (HealthDay News) -- In the wake of a widely publicized report advising against prostate-specific antigen (PSA) testing for prostate cancer, a new study finds not screening would triple the number of U.S. men developing advanced cancer.

Testing, on the other hand, might keep some 17,000 men each year from receiving a diagnosis of late-stage prostate cancer -- cancer that has spread and is far less curable -- the study finds.

"PSA testing, for all its pluses and minuses and all that . . . permits you to catch the disease earlier," said lead researcher Dr. Edward Messing, chair of urology at the University of Rochester Medical Center in Rochester, N.Y.

"These people are all going to die, they are going to die incredibly expensively and die miserably," he said, referring to the many men whose diagnoses would be delayed by not testing. "I don't know that all these people could be saved with PSA testing," but many could, he added.

The report was published online July 30 in the journal Cancer.

Messing said the annual number of prostate cancer deaths dropped from about 42,000 in the 1990s to 28,000 now. "The only thing that can explain that is PSA early detection and treatment," he said.

Many cases of prostate cancer are not life-threatening, which is why testing is controversial. The U.S. Preventive Services Task Force (USPSTF) in May recommended against routine PSA screening, saying too many non-lethal cancers were being treated aggressively, exposing men who didn't need treatment to serious side effects such as impotence and urinary incontinence.

But Messing disagreed with that advice. Condemning PSA testing "wasn't a brilliant conclusion," he said.

For the new study, Messing's team compared information from the U.S. Surveillance, Epidemiology, and End Results database for the years 1983 to 1985 -- immediately before widespread PSA testing started --- to data from 2006 through 2008.

In the 2008 data, 8,000 cases of prostate cancer were diagnosed after the malignancy had spread to other parts of the body.

Using these cases as a base, the researchers constructed a model that used data of advanced cancer diagnosed in the 1980s and predicted how many cases of advanced cancer would have been diagnosed in 2008 if PSA testing was not done.

Their model showed instead of 8,000 actual cases in 2008, about 25,000 cases would have been diagnosed.

But the USPSTF maintains the benefits of testing are overrated. "The task force recommends against prostate cancer screening using the PSA test, as the potential benefit does not outweigh the harms," said Dr. Michael LeFevre, co-vice chair of the task force and professor in the department of family and community medicine at the University of Missouri School of Medicine.

As a result of treatments for PSA-detected prostate cancer, one out of 1,000 men screened in the United States develops a blood clot in his legs or lungs, two will have a heart attack or stroke, and up to 40 are left impotent or with urinary incontinence, LeFevre said.

"At best, only one of these 1,000 men who were screened avoids dying from prostate cancer for at least 10 years," LeFevre said. "In addition, about one in every 3,000 men screened dies as a result of surgery to treat cancer detected by the PSA test."

Still, the task force recognizes that "some men may continue requesting the PSA test and some physicians may continue offering it," LeFevre said.

Before getting this blood test -- which measures a protein in cells of the prostate gland -- men should learn about the pros and cons, he said. "The decision to start or continue screening should reflect an understanding of the possible benefits and known harms, and should respect each individual's preferences."

Messing advises men with a family history of prostate cancer or urinary symptoms to have a PSA test. Men with no family history or symptoms should discuss PSA testing with their doctor, he added.

Messing pointed out that screening-detected cancer doesn't mean surgery, chemotherapy or radiation treatment must follow. Most cases can be watched for some time, he said.

Dr. Otis Brawley, chief medical officer for the American Cancer Society, said over the past few years a number of studies have been published on the benefits and harms of PSA testing.

"None of these studies can be considered decisive other than in proving that there are some harms associated with treatment," he said. The American Cancer Society still supports screening for certain men in consultation with a physician.

Prostate cancer is the second-leading cause of cancer death among men in the United States. In 2012, more than 240,000 new cases are expected to be diagnosed, and 28,000 men will die from the disease, researchers say.

More information

For more information on prostate cancer, visit the U.S. National Cancer Institute.

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New lipid screening guidelines for children overly aggressive, experts say

ScienceDaily (July 23, 2012) — Recent guidelines recommending cholesterol tests for children fail to weigh health benefits against potential harms and costs, according to a new commentary authored by three physician-researchers at UCSF.

See Also:Health & MedicineChildren's HealthCholesterolDiet and Weight LossHealth PolicyHeart DiseaseDiseases and ConditionsReferenceLow density lipoproteinHigh density lipoproteinCholesterolGrowth hormone deficiency

Moreover, the recommendations are based on expert opinion, rather than solid evidence, the researchers said, which is especially problematic since the guidelines' authors disclosed extensive potential conflicts of interest.

The guidelines were written by a panel assembled by the National Heart, Lung and Blood Institute ( NHLBI) and published in Pediatrics, in November 2011. They also were endorsed by the American Academy of Pediatrics. The guidelines call for universal screening of all 9 to 11-year-old children with a non-fasting lipid panel, and targeted screening of 30 to 40 percent of 2 to 8-year-old and 12 to 16-year old children with two fasting lipid profiles. Previous recommendations called only for children considered at high risk of elevated levels to be screened with a simple non-fasting total cholesterol test.

The call for a dramatic increase in lipid screening has the potential to transform millions of healthy children into patients labeled with so-called dyslipidemia, or bad lipid levels in the blood, according to the commentary by Thomas Newman, MD, MPH, Mark Pletcher, MD, MPH and Stephen Hulley, MD, MPH, of the UCSF Department of Epidemiology and Biostatistics and e-published on July 23 in Pediatrics.

"The panel made no attempt to estimate the magnitude of the health benefits or harms of attaching this diagnosis at this young age," said Newman. "They acknowledged that costs are important, but then went ahead and made their recommendations without estimating what the cost would be. And it could be billions of dollars."

Some of the push to do more screening comes from concern about the obesity epidemic in U.S. children. But this concern should not lead to more laboratory testing, said Newman. "You don't need a blood test to tell who needs to lose weight. And recommending a healthier diet and exercise is something doctors can do for everybody, not just overweight kids," he said

The requirement of two fasting lipid panels in 30 to 40 percent of all 2 to 8-year olds and 12 to 16 -year- olds represents a particular burden to families, he said.

"Because these blood tests must be done while fasting, they can't be done at the time of regularly scheduled 'well child' visits like vaccinations can," said Newman. "This requires getting hungry young children to the doctor's office to be poked with needles on two additional occasions, generally weekday mornings. Families are going to ask their doctors, 'Is this really necessary?' The guidelines provide no strong evidence that it is."

The authors note that the panel chair and all members who drafted the lipid screening recommendations disclosed an "extensive assortment of financial relationships with companies making lipid lowering drugs and lipid testing instruments." Some of those relevant relationships include paid consultancies or advisory board memberships with pharmaceuticals that produce cholesterol-lowering drugs such as Merck, Pfizer, Astra Zeneca, Bristol-Myers Squibb, Roche and Sankyo.

"The panel states that they reviewed and graded the evidence objectively," said Newman. "But a recent Institute of Medicine report recommends that experts with conflicts of interest either be excluded from guideline panels, or, if their expertise is considered essential, should have non-voting, non-leadership, minority roles."

Evidence is needed to estimate health benefits, risks and costs of these proposed interventions, and experts without conflicts of interest are needed to help synthesize it, according to Newman. He said that "these recommendations fall so far short of this ideal that we hope they will trigger a re-examination of the process by which they were produced."

Newman and Hulley have no disclosures. Pletcher has NIH funding to support research on targeting of cholesterol-lowering medications to prevent cardiovascular disease.

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Doctors Spar Over Cholesterol Screening in Kids

HealthDay – 1 hr 40 mins ago MONDAY, July 23 (HealthDay News) -- Researchers are debating the merits of recent guidelines that recommend all children aged 9 through 11 be screened for high cholesterol levels, along with certain groups of younger children and teenagers.

The guidelines were written by a panel convened by the U.S. National Heart, Lung, and Blood Institute, endorsed by the American Academy of Pediatrics and published in the journal Pediatrics last November.

But now doctors publishing in the current issue of Pediatrics say the guidelines are too aggressive and not based solidly on evidence. The paper is joined by a rebuttal from the authors of the guidelines.

The critics of the guidelines make many arguments, including that the guidelines were based more on expert opinion than on solid evidence and that many authors of the guidelines reported industry disclosures.

Dr. Stephen Daniels, chairman of the guidelines panel and head of pediatrics at the University of Colorado School of Medicine in Aurora, defended the panel Monday to the Associated Press.

Industry ties "were vetted during the discussions of the panel and I think really did not influence the debate," he told the AP.

Daniels, a co-author of the rebuttal, reported having worked as a consultant or advisory board member for Abbott Laboratories, Merck and Schering-Plough, now part of Merck. Seven other panel members also made disclosures.

But the critics had other objections as well.

"There is expense and inconvenience to the family to have to get to the doctor before breakfast," said Dr. Thomas Newman, co-author of the journal commentary article, referring to the recommendation that higher-risk 2- to 8-year-olds and 12- to 16-year-olds be screened after fasting.

There also is the issue of potentially giving lifetime medication to a large group of people. The guidelines estimated that about 1 percent of kids would be put on cholesterol-lowering medications if the guidelines were followed.

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Better Health Screening Urged for Female College Athletes

HealthDay – 4 hrs ago THURSDAY, June 21 (HealthDay News) -- Shortfalls in the screening of female college athletes for a trio of medical issues called the "female athlete triad" could put them at risk for lifelong health problems, according to a new study.

The triad refers to the interrelationship between energy availability, menstrual function and bone mineral density. Research has shown that many female athletes do not take in enough nutrition, which leads to the absence of menstrual periods, and loss of bone density and strength.

Medical College of Wisconsin researchers surveyed 257 NCAA Division I universities to find out when and how often athletes underwent physical examinations and had their health histories checked. The researchers also evaluated the pre-participation examination forms used to further assess athletes' health.

Sixty-three percent of the university athletic programs only completed a full medical history and examination on freshmen and transfer athletes, instead of on all athletes every year or every two years.

Only 9 percent of the universities had nine or more of the 12 Female Athlete Triad Coalition screening recommendations on their pre-participation exam forms, the investigators found.

"For an accurate picture, these forms really need to include a 72-hour food record to measure energy intake," corresponding author Dr. Anne Hoch, professor of orthopedic surgery and director of the women's sports medicine program, said in a Medical College of Wisconsin news release.

"An exercise history or an accelerometer, which is an inexpensive way to measure energy expenditure, is also helpful. These screening tools may result in early identification of athletes at risk for the triad," she added.

Further research is required to determine the most sensitive and specific items to include on a screening tool for the Female Athlete Triad, the researchers suggested.

The study was published in a recent online edition of the Clinical Journal of Sports Medicine.

More information

The Nemours Foundation has more about the female athlete triad.

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Doctors disagree on when to stop PSA screening

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Sigmoidoscopy an option for colon cancer screening

Reuters – 2 hrs 26 mins ago NEW YORK (Reuters Health) - Screening for colon cancer using a flexible tube -- which is less invasive and more convenient than colonoscopy -- may also help prevent new cases and deaths from the disease, a new study suggests.

In a large trial of more than 150,000 older U.S. adults, those who were randomly assigned to get screened using so-called flexible sigmoidoscopy on two different occasions were 21 percent less likely to get colon cancer than those not offered the screening.

They were also 26 percent less likely to die of cancer, probably because screening picked up pre-cancerous lesions and early-stage cancers before they could cause serious harm, researchers reported Monday in the New England Journal of Medicine.

Colonoscopy "is a very unpleasant thing," said Dr. Alfred Neugut, an epidemiologist and oncologist from Columbia University in New York, who wasn't part of the study team.

"Sigmoidoscopy is a much less elaborate procedure, so you can basically walk into the doctor's office and get it on the spot

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Screening for Lung Cancer Might Benefit Those at Highest Risk

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Screening Women for Domestic Violence Could Help Prevent Abuse

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U.S. Panel Rejects Ovarian Cancer Screening

HealthDay – 1 hr 22 mins ago TUESDAY, April 10 (HealthDay News) -- A leading U.S. government panel has renewed its 2004 recommendation that women at average risk for ovarian cancer not get screened for the disease.

The currently used blood test and transvaginal ultrasound may cause more harm than benefit for those patients, according to draft recommendations issued Tuesday by the U.S. Preventive Services Task Force.

"Currently, the task force does not recommend screening for ovarian cancer," said Dr. David Grossman, a member of the task force and senior investigator with Group Health Research Institute in Seattle. "The tests that we have, unfortunately, just aren't very accurate and, with a lot of false positives, a lot of women get harmed with unnecessary biopsies and surgeries."

Women with a family history of ovarian cancer should be referred for genetic testing and counseling, the recommendations also state.

Two methods are currently used to test for ovarian cancer, a blood test which looks for the tumor marker CA-125 and a transvaginal ultrasound, Grossman explained.

However, a large study published last year found no difference in mortality between women who were randomly assigned to receive a blood test plus the ultrasound compared to those who had "usual care."

What's more, some 10 percent of women who underwent screening received a false-positive result and one-third of these had an ovary removed unnecessarily.

Another study estimated that 33 surgeries were needed to diagnose one case of ovarian cancer using the blood test/ultrasound screening.

Preliminary data from yet another trial, ongoing in the United Kingdom, also turned up false-positive results in about 10 percent of women undergoing screening. Half of those women had surgery and about 4 percent of these experienced a major complication from the surgery.

Like many screening tests, the blood test plus ultrasound for ovarian cancer "doesn't work, is potentially dangerous and also costs a lot of money," said Dr. Jay Brooks, chairman of hematology/oncology at Ochsner Health System in Baton Rouge, La.. "You're giving people a false sense of security, and it creates a lot of false positives which ultimately results in a lot of unnecessary surgeries."

Yet, many doctors still perform the tests because women demand it, Brooks noted.

With no new data affirming the benefit of CA-125 screening plus ultrasound, the new draft recommendations essentially reaffirm 2004 recommendations.

They are also in line with recommendations from the American Cancer Society and the American Congress of Obstetricians and Gynecologists (ACOG), Grossman said.

This leaves women with no good test to screen for ovarian cancer, considered a "silent killer" because symptoms are often noticed too late to be treatable.

"At the present, we do not have a good screening test for ovarian cancer," Brooks said.

And there are no other techniques on the horizon, Grossman added.

The draft recommendations will be posted on the task force website, and physicians and members of the public and of professional societies are invited to comment.

Final recommendations may be out in as soon as two months, Grossman said.

More information

The U.S. National Cancer Institute has more on ovarian cancer.

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Obese White Women Shying Away From Colon Cancer Screening

HealthDay – 2 hrs 26 mins ago WEDNESDAY, April 4 (HealthDay News) -- Obese white women are less likely than normal-weight white women or blacks of any weight or gender to seek potentially life-saving colon cancer screenings, according to a new study.

This reluctance is especially serious because obesity is associated with a higher risk for colon cancer and an increased risk of death from the disease, noted study leader Dr. Nisa Maruthur, an assistant professor in the general internal medicine division at Johns Hopkins University School of Medicine in Baltimore.

"Being concerned about your weight usually is good, but here it appears to be keeping people from a test we know saves lives," Maruthur said in a Hopkins news release. "Obese white women may avoid screening because they feel stigmatized and embarrassed to disrobe for the tests."

Colonoscopy and fecal occult blood tests are two methods of colon cancer screening. The U.S. Preventive Services Task Force recommends that adults aged 50 to 75 undergo colonoscopy on a periodic basis, but only 20 percent of women and 24 percent of men over age 50 do so, the study authors pointed out in background information in the news release.

For the new study, the researchers reviewed the findings of 23 published studies that included information on body mass index (BMI) and colon cancer screening. BMI is a measurement that takes into account height and weight. A BMI between 18.5 and 24.9 is considered normal weight, between 25 and 29.9 is considered overweight and 30 or more is considered obese.

Overall, the Hopkins team found no link between higher BMI and lower rates of colon cancer screening. They did find such a link in obese white women, however.

Compared to normal-weight white women, those with a BMI between 30 and 34.9 were 13 percent less likely to be screened, and those with a BMI of 40 or higher were 27 percent less likely to be screened.

There was some indication that obese white men also are reluctant to undergo colon cancer screening, but further research is needed to confirm that data.

The study is published in the April 4 online issue of the journal Cancer Epidemiology, Biomarkers and Prevention.

Previous research by the same Johns Hopkins team found that obese white women are also less likely to seek mammography breast cancer screening and Pap smear screening for cervical cancer.

In addition to feeling reluctant to disrobe, another reason obese women may avoid the screening is because they may be dealing with other higher-priority health concerns, the researchers suggested.

More information

The U.S. National Cancer Institute has more about colorectal cancer screening.

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