Wednesday, Dec. 14, 2011

Dr. Virginia A. Moyer

Routine cancer screening is an undeniable boon of modern medicine, saving thousands of lives by catching tumors early. So it was a shock when, in early October, the U.S. Preventive Services Task Force (USPSTF) recommended against routine prostate cancer screening, using PSA tests, in healthy men. The panel said the test doesn't save lives overall, and that its potential risks — needless surgery, impotence, incontinence — outweigh its benefits. Behind the decision was the task force's chair, Dr. Virginia A. Moyer, a pediatrics professor at Baylor College of Medicine. Since becoming chair of the panel in March, Moyer has led the public charge against overscreening — a view privately held by many in the medical community for decades — which can lead to unnecessary damage without saving lives.

In the case of prostate cancer, the widely used PSA test detects levels of prostate-specific antigen in the blood — a protein released by prostate cells that may indicate cancer. There's no question that the test can and has saved lives, but Moyer and colleagues argue that many prostate cancers caught by the test are so slow growing that men would die of some other cause long before suffering the effects of cancer. Even when it picks up invasive cancer, it may not help, since early treatment of aggressive disease hasn't been shown to benefit patients. The USPSTF recommendation was controversial, since millions of men over 50 get the PSA test each year (though the advice was perhaps not as riotously debated as the USPSTF's 2009 recommendation to delay routine mammograms in women until age 50). But Moyer believes that even such basic preventive strategies like cancer screening can fall within the realm of expensive, invasive and unnecessary medical intervention — and that eliminating it could improve patients' lives and potentially save millions in health care dollars.