Experts Issue Call to Reconsider Screening for Breast Cancer and Prostate Cancer

By Elizabeth Fernandez, UCSF News Office | October 27, 2009

Twenty years of screening for breast and prostate cancer - the most diagnosed cancer for women and men - have not brought the anticipated decline in deaths from these diseases, argue experts from the University of California, San Francisco and the University of Texas Health Science Center at San Antonio in an opinion piece published in the "Journal of the American Medical Association."

Instead, overall cancer rates are higher, many more patients are being treated, and the incidence of aggressive or later-stage disease has not been significantly decreased, the authors conclude. Current screening programs are leading to "potential tumor over detection and over treatment," they write in the Oct. 21, 2009 issue of JAMA.

"Screening does provide some benefit, but the problem is that the benefit is not nearly as much as we hoped and comes at the cost of over diagnosis and over treatment," said Laura Esserman, MD, MBA, professor of surgery and radiology, director of the UCSF Carol Franc Buck Breast Care Center, and co-leader of the breast oncology program at the UCSF Helen Diller Family Comprehensive Cancer Center.

"We need to focus on developing new tools to identify men and women at risk for the most aggressive cancers, to identify at the time of diagnosis those who have indolent or 'idle' tumors that are not life-threatening," she added. "If we can identify groups of patients that don't need much treatment, or don't need to be screened, wouldn't that be great? Screening is by no means perfect. We should want to make it better. For both breast and prostate cancer we need to invest in changing our focus from the cancers that won't kill people to the ones that do."

Breast cancer, the most common cancer in women, is a devastating and costly disease, striking more than 200,000 women annually and killing more than 40,000 women each year, reports the American Cancer Society. Prostate cancer is the most common form of cancer in men and the second most common cause of cancer death after lung cancer. This year, an estimated 192,280 men will be diagnosed with the disease, and 27,360 men will die from it, according to estimates from the American Cancer Society.

The two diseases account for 26 percent of all cancers in the U.S., with an estimated 386,560 patients diagnosed annually.

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