Health officials question value of many routine screenings

St. Louis Post-Dispatch

ST. LOUIS — With cancer screenings, more is always better.

At least that’s what people have been told for years — get mammograms, Pap smears, colonoscopies and prostate tests as early and often as possible to catch cancer before it spreads.

But a new way of thinking has started to take hold that looks at the risks along with the benefits and concludes that universal routine screenings may not always be the best option for improving public health.

The chief medical officer of the American Cancer Society, which generally supports screenings, has said he plans to issue an alert soon saying the benefits of some screenings have been exaggerated.

This week, two medical groups relaxed their screening guidelines for breast and cervical cancers.

Women only need to be screened for cervical cancer between ages 21 and 65, according to new guidelines from the American College of Obstetricians and Gynecologists. The leading gynecological society said women should receive Pap tests every two years until age 30 and every three years after that, instead of annually.

Women were also advised this week in a report from the U.S. Preventive Services Task Force that mammograms are usually unnecessary before age 50.

Both recommendations, for women with an average risk for cancer, were based on an analysis of data looking at the benefits of screenings as well as the risks from false positives and unnecessary treatments.

“Both these groups said start [screening] later, and do it less frequently, recognizing that they could preserve the benefits of screening and reduce some of the harms,” said Dr. H. Gilbert Welch, author of “Should I Be Tested for Cancer?” and professor at Dartmouth College in Hanover, N.H. “That’s a real sign of some rational thinking that often has been missing in health care, where the presumption is it’s always better to do more.”

The debate over screenings was first launched when prostate- cancer tests gained popularity in the early 1990s and mass screenings turned up a lot more disease than doctors expected. Subsequent surgery and other treatments for prostate cancer can lead to serious side effects including impotence and incontinence. Doctors have come to realize that many prostate cancers are so slow growing as to never become deadly.