Journal of the National Cancer Institute Advance Access originally published online on January 29, 2008
JNCI Journal of the National Cancer Institute 2008 100(3):222-223; doi:10.1093/jnci/djm294
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© The Author 2008. Published by Oxford University Press.
CORRESPONDENCE |
Response
Affiliation of author: Public Health, University Hospitals, Amiens, France
Correspondence to: Alain Braillon, MD, Public Health, University Hospitals, Amiens, France (e-mail: braillon.alain{at}chu-amiens.fr).
Crawford's editorial looks like an advertising slogan (1). The title "Is a screening interval of every 4 years for prostate cancer acceptable?" should be changed to "Screening for prostate cancer still unacceptable." A physician's goal should be to maximize effectively administered therapies and minimize unnecessary therapies, particularly given that the treatment of localized prostate cancer often has major consequences on quality of life (2). Yet, the impact on mortality remains unproven despite widespread screening for more than 15 years! Of the 19 major medical organizations worldwide, only the American Cancer Society and the American and the French Urological Associations recommend screening men for prostate cancer with annual prostate-specific antigen testing (3). Two of these three organizations have a major conflict of interest. I follow the guideline of the US Preventive Services Task Force (4), which concluded that "the evidence is insufficient to recommend for or against routine screening for prostate cancer." The main drawback of cancer screening is overdiagnosis. The risk–benefit ratio is still debated for breast cancer screening (5). For prostate cancer screening, the risk of overdiagnosis is obvious.
Again, the editorial's conclusion looks like an advertising slogan, "Men aged 50 years could combine a routine colonoscopy and prostate biopsy!" This promotes unproven and dangerous albeit lucrative investigations. At the present time, colorectal cancer screening is based on a noninvasive test that detects fecal occult blood.
The editorial in the Journal could have been more evidence driven.
REFERENCES
1. Crawford ED. Is a screening interval of every 4 years for prostate cancer acceptable? J Natl Cancer Inst (2007) 99:1280–1281.
2. Sharifi N, Kramer BS. Screening for prostate cancer: current status and future prospects. Am J Med (2007) 120:743–745.[CrossRef][Web of Science][Medline]
3. Gignon M, Braillon A, Chaine FX, Dubois G. Le dépistage du cancer de la prostate: hétérogénéités des recommandations. Une exception française? Can J Public Health (2007) 98:212–216.[Web of Science][Medline]
4. U.S. Preventive Services Task Force. Screening for prostate cancer: recommendation and rationale. Ann Intern Med (2002) 137:915–916.
5. Gotzsche PC. Screening for breast cancer with mammography. Cochrane Database Syst Rev. (2006) 4. CD001877.
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J Natl Cancer Inst 2008 100: 222.
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