Category Archives: Otis W. Brawley

Prostate Cancer Screening: The Scientific View

By Otis W. Brawley, MD, FACP

Actor Ben Stiller revealed Tuesday that he had been diagnosed with prostate cancer two years ago and he discussed his experience in an article published on Medium.  Stiller’s prostate cancer story is not unusual. There are countless instances where men with no symptoms, no known family history, no other risk factors, undergo screening for prostate cancer, who have prostate cancer detected, treated, and are left better off. And it would be hard to convince these men that screening did not save their lives.

But we now know that the majority of men with prostate cancer will not die of their disease, whether they receive aggressive treatment, are watched carefully, or even if it was never diagnosed.

The harsh truth is that even under the best conditions, with careful screening, some men will still die of prostate cancer.

This is why no major health group recommends all men be screened. The PSA test can be useful, but it is not perfect, not by a longshot.

Mr. Stiller admits he is “not offering a scientific point of view here, just a personal one…” So what is the scientific point of view? Twelve professional organizations in the United States and Europe have looked at the scientific data.… Continue reading →

Weighing the Benefits and Risks of Lung Cancer Screening

By Otis W. Brawley, MD, FACP

 

This week the American Cancer Society announces its lung cancer screening guidelines. In short, we recommend that health care professionals with access to high-quality lung cancer screening and treatment centers should discuss screening with healthy patients aged 55 years to 74 years who have at least a 30-year history of pack-a-day cigarette smoking and who currently smoke or have quit within the past 15 years. The health care professional and patient should discuss all the known benefits and known harms associated with lung cancer screening.

These guidelines were developed after a meticulous process in which a group of cancer screening and treatment experts reviewed all the major lung cancer screening studies that have been published over the past several decades.  [more]

Benefits vs. harm

The National Lung Screening Trial (NLST), published in 2011, heavily influences this recommendation. The NLST is a well-designed clinical trial.  It studied 53,454 men and women in good health, aged 55 and over and at high risk of lung cancer because of their smoking history. The study assigned half of them to the test group of low-dose spiral CT scan, and half of them to a control group that received the standard single view chest X-ray.… Continue reading →

The Prostate Cancer Quandary

EDITOR’S NOTE: This blog was originally published on June 29. Due to recent questions on this topic, it’s been reposted. News reports say the United States Preventive Services Task Force will next week release new recommendations saying that healthy men should no longer receive a PSA blood test to screen for prostate cancer. Reports say the USPSTF will say the test does not save lives and often leads to more tests and treatments that needlessly cause pain, impotence and incontinence. Otis W. Brawley, M.D., chief medical officer of the American Cancer Society, says the Society cannot comment on the evidence review or on the recommendations until they are made public.

By Otis W. Brawley, MD, FACP

 

 

Prostate cancer is a major public health problem.   The American Cancer Society estimates that 240,890 American men will be diagnosed with prostate cancer in 2011 and 33.720 will die of it.  It is the second leading cause of cancer death among men, only surpassed by lung cancer. 

 

Prostate cancer screening became common in the U.S. in the early 1990s and dramatically changed the demographic of cancer in the U.S. Prostate cancer quickly became the most commonly diagnosed non-skin cancer.  Today an American male has a lifetime risk of prostate cancer diagnosis of about 1 in 6 and a lifetime risk of dying of only 1 in 36.… Continue reading →

Funding the Best Science Helps Us All

By Otis W. Brawley, MD, FACP

From time to time, I encounter advocates for research in certain diseases. These are people who want better answers for a specific cancer. Oftentimes these folks or a relative has had that particular cancer.  They often ask, why is so little money spent on pancreatic cancer, ovarian cancer, or even lung cancer?   Why can’t we spend more? These are reasonable questions, and I want to try to address them in this piece. 

First I caution against what I call “disease Olympics.”  This is when advocates for one disease try to increase funding for their disease by decreasing funding for another disease. I have often seen this in my 25 years as an oncologist, researcher, and scientific administrator. I would point out that 90% of the grants that are submitted and judged worthy of funding to the National Cancer Institute, American Cancer Society, and other research-funding organizations are not funded due only to a lack of money. I believe the wise advocate tries to get more money for all cancer research and does not try to undermine another disease in favor of the disease that he or she is interested in. [more]

The second reason to support the best scientific ideas as judged by the rigors of scientific peer review is that we can often benefit multiple diseases by funding the best science.  Indeed, one can argue that funding the best ideas in, say, lung cancer and not the better scientific idea in another cancer could possibly hold back the advancement of lung cancer research.… Continue reading →