It is always a powerful moment when the media and
But sometimes strange things happen on the way to the chapel. One of those is noted in an email I received late yesterday announcing that Brad Garrett is going to have a prostate cancer screening examination shown on national TV as part of this program.
That certainly will be interesting on several counts.
First is the obvious: having a rectal exam on national television takes us to a new level. Whether or not that is appropriate in the eye of the public remains to be seen. I guess it all depends on how it is filmed. Let’s just say as a doctor it isn’t something I would recommend as a TV highlight.
Then there is the possible impact on prostate cancer screening. I guess the reason Mr. Garrett is doing this is to raise awareness that in his opinion digital rectal examinations will save lives. Consequently, he is willing to bare himself in the name of better health.
But the truth is not so clear cut. Certainly not as clear cut as when Katie Couric allowed viewers to watch as she underwent a colonoscopy television, a momentous and brave event. It also contributed mightily to our awareness about colorectal cancer screening, and led to a clear, demonstrable increase in colorectal cancer screenings. That increase was dubbed “the Couric effect,” and undoubtedly has saved lives.
How can I say that?
I can say that because we knew at the time (and it is still unfortunately the case, but the statistics have been slowly improving) that the majority of adults ages 50 and over in the United States were not getting screened for colorectal cancer as recommended by the American Cancer Society and other respected organizations. Increasing awareness would mean more people would be screened for this preventable and treatable disease.
We knew then and know now that thousands of lives lost to colorectal cancer could be saved every year in this country if we did what we already know about screening for this cancer. That is a proven fact
Prostate cancer screening is an entirely different story.
When Mr. Garrett has his prostate exam broadcast nationwide, what message will he be sending?
Here is what the American Cancer Society and many other reputable organizations have to say about the effectiveness of prostate cancer screening: we simply do not have the evidence to show that it saves lives.
That may be difficult for you to believe, but that in fact is the science. There are no definitive trials that conclusively demonstrate that PSA tests and digital rectal examinations (DRE) reduce deaths from prostate cancer.
The evidence surrounding the benefits of DRE is uncertain at best. We were doing DREs for prostate cancer many, many years before the PSA became available. And, like the situation in breast cancer before mammography, if we felt a prostate cancer we thought it was early when most of the time it was not.
The American Cancer Society does not support routine screening for prostate cancer at this time.
The Society does say that men at routine risk of prostate cancer who are ages 50 and over should be offered prostate cancer screening by their health care clinicians. African American men should be screened beginning at age 45. But these actions should be taken only in the context of a full discussion between the men and their clinicians about the known benefits and risks of prostate cancer screening.
The problem with all of this is that there are real risks of harm that come from prostate cancer screening. Surgery and radiation therapy clearly have side effects, some of them very serious. If we are going to treat these cancers—many of which do not result in death—then we should be aware that there is a balance between the benefits of treatment and the risks of harm from that treatment.
I wrote a couple of weeks ago that the United States Preventive Services Task Force came out clearly against prostate cancer screening for men ages 75 and over. For younger men, they continued to note that the evidence remains inconclusive whether or not prostate cancer screening saves lives. Their recommendation remains that doctors and patients have to have a discussion of the risks and benefits of prostate cancer screening before they decide whether or not to take the test.
So I come back to the core question: what message are we sending the nation when several minutes of valuable air time are taken up with a man getting a prostate exam on national TV?
We watch our celebrities, we listen to what they say, and they serve as role models for what we do.
If we don’t know that prostate cancer screening really saves lives and in particular that DRE makes much of a difference (it can find prostate cancers that the more sensitive PSA might miss from time to time), then what good is it for Mr. Garrett to bare himself to the world to raise money for cancer research? Is his examination going to be preceded by a detailed explanation of what we know and don’t know about prostate cancer screening? Somehow, I doubt it.
I admire his willingness to advance the cause of cancer research. I just wish there was a better way to do it that was more consistent with the medical evidence and recommended practice.