At this point, the jury really seems to be out about whether the Prostate Specific Antigen level (PSA) test for men and the mammograms for women are actually useful screening tests. According to this site,
Of course, men who have had elevated PSA levels, discovered a prostate cancer and had it removed would probably argue with that advice.
The risk in both cases is that the screening detects cancers which may not have ever become clinically significant in the patient’s lifetime, and once detected, cancers are usually treated, which can lead to psychological, physical, and financial harm to the patient.
On the other hand, people do die from breast and prostate cancers, and it is very counter-intuitive to reject methods that purport to screen out early, easily treatable versions of the diseases.
So, my question - where do you fall on this issue? As a man in the recommended age, do you get your PSA levels tested? If you had an elevated level, would you move on with further tests, up to and including prostatectomy and radiation? As a woman in the recommended age group, do you get your mammograms done? Would you go as far as mastectomy and radiation based on a positive screening result? How do you feel about getting these screening tests done, knowing that the tests are not as useful as we have been led to believe?
I’m not yet in the mammogram age group, but I plan on starting screenings when my doctor advises. I know that it can lead to false positives, but I think there are some steps between “positive screening result” and “mastectomy.” There are different imaging techniques. There are biopsies. I agree that a spot on a mammogram tends to be nothing, and the stress of waiting and wondering is hell, but I feel like screening is a good idea.
As you say, some cancers won’t be clinically significant in the patient’s lifetime, but I think that means we need to adjust our view of “cancer,” not scale back screenings. There are ways to distinguish the aggressive tumors from the slow-and-steadies (although there’s always room for improvement), and I believe that the treatment should match the aggression of the tumor. For example, my uncle is 68 and has been diagnosed with prostate cancer after a high PSA and a positive biopsy. But they’re not worried about it spreading, for now, and they’re just watching and waiting. Nobody wants to just leave a cancer there, and I can understand that, but sometimes maybe it’s the smartest and healthiest thing to do.
My urologist has taken my PSA and done a prostate exam at my regular appointments for the last several years. Annually now that I’m over 50. I’ll keep doing that until he recommends otherwise. Or until he retires and my next doc recommends otherwise. I plan on continuing with an annual PSA and digital rectal exam. Getting blood from me is easy. The DRE is not my idea of fun, but it’s quick and the peace of mind is well worth it. I’ve only gotten good news so far, but if I’m going to get bad news I’d rather hear about it early, and start the follow ups or treatment sooner rather than later. My fathr-in-law died of prostate cancer, even after being told he would probably die of another age-related syndrome. The general recommendations may be shifting but I’ll stick with the current ones until MDs I trust tell me to do something differently.
My doctor used to do a PSA every year and it was generally below 2 (2 of what, I wonder). Then in 2005 is was eight. He sent me to a urologist who repeated it. It was 5. So he recommended a biopsy. Major league unpleasant; it felt like getting shot in the nuts. Perfectly normal biopsy. So I told my doctor, “No more” and he has respected that. Now I am getting close to 77 and well past the age they are recommended.
My doctor hasn’t started testing my PSA levels, but we’ll do so in the next few years. My father is one of those who measured high, and had a fairly aggressive cancer. I’m not sure what actions I’ll actually take if I have a high reading at some point, but I’d like to have the data available to make a decision, instead of not having anything. It’s possible that in 10 years, we’ll know something new, and that the five years or so of history I’ll have is important.
I’ve had my PSA done for several years, and mine went up from steadily under 3 to over 5 (which still seems low to me compared to some of the readings). So my PCP sent me to a specialist, who was all up in my business, and decided to wait and see for another couple of tests. Finally, he decided a biopsy was called for - I agreed, because what do I know?
I have ranted about this before, the bastard did not use any sort of general anesthetic. Instead, he inserted a needle into my prostate several times for a local anesthetic before taking the samples. Men, did you know that your prostate has lots and lots of lovely nerve endings, which is why it can be sexually stimulating? DO NOT LET THEM DO THIS TO YOU! It was exquisitely painful. And all for nothing. Not just because the results were 100% clean, but because neither doctor remembered to tell me to refrain from sexual activity for at least 72 hours before the blood is drawn for the PSA test. Once I knew that, the test numbers dropped down to where they were before.
So, men everywhere, know this:
Ask your doctor if your blood test is going to include PSA, and if it is, refrain from any sexual activity (including masturbation) for at least 3 days before blood is drawn.
If you are unlucky enough to need a biopsy, insist on some kind of general relaxer/anesthetic (like what you get if you have a colonoscopy). If they won’t, go to a different specialist.
I’m still getting PSA tested once a year, but they are also taking urine. This might be for a new urine test for prostate cancer that I read about. I’m going to ask this next time to be sure.
On preview, I see Hari Seldon had the same experience. I haven’t said “no more” to PSA testing, but I will definitely say “screw you” if he wants to do another biopsy.
Roddy
I had my first mammogram at 40 like a good little woman, and then they wanted to do them annually. I went along with it for a couple years, but at that point I started getting ornery about it. There were too many questions that were answered only with, “Because that’s what they recommend.”
For example, I have no particular risk factors for breast cancer (other than breasts), but every year I get multiple increasingly strident reminders to get a mammogram. Why this obsession with my breasts, when it has never been suggested that I have a chest x-ray, even when I was a pack-a-day smoker? Why insist that I have a mammogram every year when new recommendations are for every other year for my risk profile? Why is my very urgent and well-documented risk of suicide considered to be a minor health issue (if it’s acknowledged at all), but my average breast cancer risk causes health care workers to get the vapors?
I had a mammogram at my last physical just to make my doctor happy, but it’s the last one I’ll get. I won’t accept treatment for any serious illness, so there’s no reason to waste diagnostic resources on it.
My PA insists on a mammogram with the annual physical. Last time, after everything else was done, I was getting ready to leave and she actually took me by the arm to the mammo room.
About 15 years ago I spent a week stressed out and getting ready to die because the mammo showed “something”. They did a biopsy and the result – “must be scar tissue”. WTF? Scar tissue from what?
All the mammos have been clear since then. There’s no breast cancer in my family, and that includes two grandmas, mom and five aunts.
I’ll have another one soon (Monday, in fact), but I’m only doing it to get my PA off my back.
It is not unusual these days for health workers, hospitals, medical centers, and the like to be subjected to rating these days, upon which such important decisions as whether or not insurance companies will deal with them, or certain public monies will be made available. “What percentage of your female patients of X age or higher get mammograms?” is a frequent questions in such ratings. “How many suicides did you prevent last year?” is not.
Yes, that’s a cynical attitude, but having worked for both the health insurance industry and at a medical clinic, as well as having friends and family in health care, I can’t help but think that sort of thing is a factor.
I’m 43 and discussed getting a PSA test as my mother’s brother died of prostate cancer when he was about 70. His son also had prostate cancer when he was about 50 that was treated successfully.
My doctor’s question to me was this: if your PSA tests high, what are you going to do about it?
His feeling is that the PSA shows too many false positives and the treatment can often be worse than the cure.
I’m only 33 with not a speck of family history so there’s been no mention of early testing from my gynecologist. My GP doesn’t talk about my boobs. He’s never even seen me with my shirt off so I doubt he’ll ever bring it up.
Because there is no evidence for benefit of screening asymptomatic patients (smokers or not) with x-ray. It’s pretty rare to find a lung cancer big enough to show up on an x-ray but not causing any symptoms, and even if you did find one you’d have to show that catching it at that point led to a significantly better outcome than if you had waited until it became symptomatic (which seems true intuitively but isn’t necessarily).
There is evidence for screening smokers with a CT scan, and earlier this year the US Preventative Services Task Force released guidelines that people between age 55 and 79 with a 30 pack-year history of smoking (and who are either still smoking or quit in the last 15 years) should get a CT scan annually. This hasn’t made its way into a lot of practices yet, but it will get there.
The new guidelines were not without controversy, and some recommending bodies still suggest getting one every year. The numbers favor the every-other-year approach, but no doc wants to be the one whose patient got an aggressive breast cancer six months out from her last mammo that gets found 18 months later instead of six.
Honestly, it’s because as a primary care physician I can do something about your breast cancer risk–namely, remind you to get a mammogram–but there is very little I can do about your depression/suicide risk. I can talk to you about it, give you some very basic medications, and refer you out, but that’s really about it.
If someone came to me with moderately high blood pressure and truly horrible teeth, I’d focus on his high blood pressure, because that part is what I do. Even though PCP’s theoretically treat everything, we don’t do it all equally well.
Male, 64.
DRE at 55, with the plan being one every 10 years.
Never had PSA.
Reading what I have over the last few years, I’'m guessing that any/every man, given enough time, will develop some level of Prostate Cancer. Big Deal.
We now know renal failure will kill me much, much sooner than that silly little prostate will.
Or the opiate + benzodiazepine + anti-depressant (also messes with same part of the brain as the benzo) will make the news.
Screw it - no more tests, no more worry (at least on that topic)
Male, currently 66. Five years ago I was in the same situation as DitNA’s father (a sudden jump in PSA). The urologist ran me through several courses of antibiotics to rule out inflammation, then did a biopsy which came back positive. After weighing the alternatives, I elected a prostatectomy. Post-op pathology showed a “high-grade” (love the term) tumor that would have killed me within ten years, with the initial symptom being intense and intractable back pain. So while I understand the concerns about false positives and risk-v-reward, in my case the PSA test was literally a lifesaver.
I still have a PSA test done since it would be the first indication that the cancer had metastasized. So far the results have been too low to measure.
I used to get the mammogram done yearly since breast cancer is in my family. Both my mom and a first cousin had it, but due to lack of health insurance and a declining faith in their effectiveness, I haven’t had one done in a few years. I do have an appt to get one done in January though.
I’ll probably settle on one every five years or so.