cancer

All Cancers aren’t created equal.  In fact, there has been discussion about changing the wording for “cancers” that aren’t as terminal or agressive as other cancers.  This NY Times article talks about how scary using the word cancer can be – especially in patients diagnoses with breast or prostate “cancers”.  

The pathologist Donald Gleason, who invented Gleason scoring for prostate tumors, wanted to rename a very common tumor — the so-called Gleason 3 + 3 — “adenosis” instead of cancer, Dr. Brawley said. His idea was that by calling a 3 + 3 “cancer,” men and their doctors would feel they had to get rid of it right away. 
Despite Dr. Gleason’s wishes, 3 + 3 cells are still called cancer.
And despite the panel’s advice about D.C.I.S., that name has not changed either. 
Cervical cancer specialists had better luck. In 1988, they changed the name of a sort of Stage 0 of the cervix. It had been called cervical carcinoma in situ. They renamed it cervical intraepithelial neoplasia, Grades 1 to 3, taking away the cancer connotation.

In this article, Four Reasons I won’t have a Prostate Cancer Blood Test, by consultant oncologist Ian Haines talks about the overmedication, surgery, and unnecesary treatments for “cancers” that aren’t fatal.  

While some prostate cancers are harmful and require treatment, many are not. So the prevailing wisdom – that early detection and treatment is best – doesn’t necessarily apply. At least 70% of men over 70 have prostate cancer detected in autopsies, and only 3% of men die because of prostate cancer.

He states that the PSA is a poor testing tool.  He states that a positive PSA only means 1 in 4 men actually have prostate cancer.  That means, 3 out of 4 men were told they have elevated PSA and prostate cancer.  

PSA tests also miss many cancers. A 2003 study found that 21% of men who had a “normal” PSA of 2.6 to 3.9 at the end of a seven-year study did, in fact, have prostate cancer. Of the men with a PSA of 2.5 or less, 15% had cancer.

So what happens to those 3 out of 4 men who are being treated for “cancer” due to an elevated PSA?  Dr. Haines days that detection and treatment comes with side effects:

One in six men will be diagnosed with prostate cancer during his lifetime. Their lives will be profoundly changed by this cancer diagnosis, whether or not they proceed with treatment.
I do not want the anxiety, depression and relationship changes that follow diagnosis, radical surgery, active surveillance or any regular monitoring.
I do not want to be impotent, which is very likely after radical treatment, or have urinary incontinence.
Even before treatment commences, after an abnormal PSA result, men are referred for a prostate biopsy: a surgical procedure that, even though it can indicate cancer, cannot give reliable information about how that cancer will behave.
I do not want the 1-2% risk of life-threatening infectionscaused by prostate biopsies.

I am a big fan of monitoring, testing, and preventing cancer – I advocate strongly for a complete approach to such things.  I would suggest continuing prostate screening with the caveat that abnormal results be treated and monitoed without being misaligned an unnecessary cancer diagnosis.