Saturday, December 31, 2011

Mr Swan May Be The World’s Best Treasurer But He Really Should Stick To The Economy!

Here is what happens when people speak outside their zone of competence.

Swan warns men of prostate 'silent killer'

Jessica Wright
December 30, 2011
Acting Prime Minister Wayne Swan has urged Australian men over 50 to make an unusual but important resolution for the New Year - a trip to the doctor for a prostate exam.
Mr Swan, who was diagnosed with prostate cancer in 2001 and lost his father to the disease, visited the Princess Alexandra Hospital in Brisbane yesterday and spoke of his battle and stressed early detection was critical to survival.
The Prostate Cancer Foundation of Australia chief executive, Anthony Lowe, said it was estimated that 20,000 Australian men would be diagnosed with prostate cancer in 2012 and 3300 would die of the disease.
Dr Lowe said it was a little-known fact that more men were diagnosed each year with prostate cancer than women were diagnosed with breast cancer, which attracted a much higher profile among the community.
Mr Swan said prostate cancer was a silent killer and men needed to inform themselves of the risks and factors that were involved with developing the disease, especially if there was a family history with the cancer.
''I had absolutely no idea that I was at risk from prostate cancer,'' he said.
''My father had died an early death from prostate cancer and despite all of that I didn't understand that I had a one in three chance of having prostate cancer.
''Think about that - if you're over 50, if you've got a brother or a father who's had prostate cancer, you've got a one in three chance of having it yourself. So if you're at risk, then you should be tested on a regular basis.''
Mr Swan said there had been a misguided view, reported in some sections of the media, that men should not necessarily take the prostate specific antigen test in addition to a GP check-up.
More here:
Here is the evidence from the world experts.

USPSTF Recommends Against Prostate Cancer Screening

The Task Force determined that the harms of screening outweighed the benefits for most men.
In October 2011, the U.S. Preventive Services Task Force (USPSTF) ignited controversy when it posted a new recommendation against prostate cancer screening. Tipping the balance against screening was the USPSTF's view that the benefits demonstrated in the two recent randomized screening trials were small at best and insufficient to outweigh the harms of screening (e.g., false-positive prostate-specific antigen [PSA] results, unnecessary biopsies, overdiagnosis of indolent tumors, and psychological effects associated with all these outcomes) and the harms of overtreating men with low-grade disease (JW Gen Med Oct 27 2011).
During 2011, several analyses expanded on the initial findings from the two major screening trials, which were published in 2009. Although the U.S. Prostate Lung, Colorectal, and Ovarian (PLCO) trial showed no overall difference in 10-year prostate cancer mortality, regardless of screening group, a new post hoc analysis demonstrated that a subgroup of screened men with no comorbidities experienced lower 10-year prostate cancer–specific mortality than unscreened men (0.17% vs. 0.31%; P=0.03). In contrast, screened men with comorbidities had higher prostate cancer–specific mortality than unscreened men (JW Gen Med Mar 3 2011).
In another analysis, proponents of screening extrapolated from the previously published European Randomized Study of Screening for Prostate Cancer (ERSPC), which had shown that screening was associated with seven fewer prostate cancer deaths per 10,000 men during 9 years of follow-up. These researchers predicted that after several more years of follow-up, the number needed to treat to prevent 1 prostate cancer–related death will drop from 48 to 18 — a more favorable benefit-harm ratio (JW Gen Med Mar 3 2011).
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The bottom line is that Mr Swan is generalising a personal experience to make a recommendation that, if implemented, will probably lead to much more harm than good.
The right approach is one that has the male over 50 and his doctor discuss the risks and benefits of PSA testing and then have the patient decide what they want to do from there, once in possession of all the facts. Paternalism from doctors has no place in decisions like this one where there is such a fine balance of potential benefit and risk of harm!
Blanket recommendations for PSA screening are just wrong and should not be made - especially by a Treasurer!
Saying 'have a conversation with your doctor' is right. Saying 'get screened with a PSA test' is plain wrong!
Back to e-Health now!


Eric Browne said...

Thanks for injecting some evidence-based research results into the PSA screening debate to counter Mr Swan's extrapolation from his one-off personal anecdote. PSA screening is a concerning issue for many men and you offer sage advice.
However, many of the studies and meta-analyses undertaken on this issue, including a large study published in the BMJ last year, do not take into account family history of prostate cancer [ "Lastly, there was insufficient evidence to analyse the impact of screening on high risk populations, such as patients with a strong family history of prostate cancer"]. An excellent explanation of the PLCO and ERSPC studies you mention is available in EUROPEAN UROLOGY 58 (2010) 46–52

Of course, with proper electronic health record systems, we could probably undertake the research without "clinical trials". Just run a few queries on the recorded data - if we had it. Alas, the proposed architecture of the PCEHR is unable to support such queries. I guess we'll have to leave it up to other countries to forge ahead in this area.

Dr David More MB PhD FACHI said...

Hi Eric,

I think that is why they said 'most men'! Obviously there is a serious chance that screening in those with a family history might be useful and as you say this is research that can happen ideally with a quality EHR infrastructure.

Happy New Year!