A Prostate Screening Picture Worth A Thousand Words

Prostate cancer early detection

The Max Planck Institute for Human Development has just kindly given us permission to post this excellent chart depicting the effects of prostate screening on men over 50. It goes with this post from yesterday — Analyzing those widespread feelings of ‘Hands off my PSA test‘ — and illustrates the reasoning behind recent recommendations against routine prostate screening for healthy men.

I love the feeling of dawning clarity as my eye passes slowly over the data and the point comes across: Hmmm, 1,000 men in each group. With prostate screening, the same number of men die of prostate cancer as without screening (red circles with a P inside). But with screening, a couple of hundred get “false positives” that worry them but turn out okay. And 20 are treated unnecessarily for prostate cancer, with all the downsides of the treatment, to no benefit (blue circles with an X inside). Okay, I think I get it now…

A couple of points from the folks at the Max Planck Institute: Continue reading

Analyzing Those Widespread Feelings Of ‘Hands Off My PSA Test’

(ABC News on Youtube)

I remember my own natural instincts about cancer screening before a friend in public health set me straight about false positives and other possible harms. I figured the more mammograms I got, the better, right? Same with tests for prostate specific antigen, or PSA, in men, no? The test can save your life. What could be bad?

A lot, of course, including potentially terrible complications from prostate surgery. And earlier this week, a federal panel issued final recommendations against routine prostate screening for healthy men. But the panel’s calculations that the tests do more harm than good have failed to convince many who reason as I used to, that catching cancer early must save lives.

In a paper that couldn’t be timelier, this month the journal Psychological Science publishes an analysis of the “uproar” over prostate screenings last October, when the panel issued its initial recommendations leaning in the same anti-PSA direction.

The Psychological Science paper identifies four psychological factors that “can help explain the furor that followed the release of the task force’s report.” They are:

• The persuasive power of anecdotal (as opposed to statistical) evidence

• The influence of personal experience

• The improper evaluation of data

• The influence of low base rates on the efficacy of screening tests.

The authors, from Ohio State University and The Max Planck Institute for Human Development in Berlin, suggest that the reaction might be different if the panel’s calculations were better explained: “Augmenting statistics with fact boxes or pictographs might help such committees communicate more effectively with the public and with the U.S. Congress.”

I’m all for better explanations. I also can’t help thinking that these psychological factors cannot apply to the experts whose opposition to the anti-PSA recommendations is quoted in this NPR story and in this previous CommonHealth post.

Putting potential arguments aside, the paper offers a wonderfully vivid explanation of public attitudes by presenting the thought experiment of a thousand older men in an auditorium:

Consider two auditoriums, each of which contains 1,000 men age 50 or older. Auditorium “Screened” contains 1,000 men who have had a PSA screening test. Auditorium “Not Screened” contains 1,000 men who have not had such a test. About 8 men from each auditorium will die from prostate cancer in the next 10 years. A very important conclusion to be drawn from these numbers is that screening does not decrease prostate-cancer mortality. How can this be, given that so many men claim to have been saved by a PSA test? Continue reading

My ‘Health Porn’: Nutrition Action Newsletter On Phony Claims

Lots of big birthdays going around these days. Massachusetts General Hospital just turned 200, as did McLean Hospital, and MIT is celebrating 150. Meanwhile, the Center for Science in the Public Interest turns 40 this month, which is not as noteworthy — and it’s not even local — but the birthday did highlight an eyebrow-raising fact: The group’s “Nutrition Action” is the world’s largest- circulation health newsletter, according to a memo by CSPI chief Michael Jacobson.

Darn. I thought I was being kind of cutting-edge when I subscribed. Turns out that edge is broad enough to fit 850,000 other subscribers. But it should be no surprise. You’ve heard glossy real-estate mags called “house porn” and gourmet mags called “food porn;” for me, Nutrition Action is a bit like health porn, in that there’s something deeply delicious about its debunking of phony food and health claims. When it comes, I throw down the rest of the mail pile and immediately start leafing through.

The March issue just came today and includes a look at cold remedies and the often-shaky evidence behind their claims. What other publication would say something this blunt? “Despite hundreds of millions of dollars in sales, there is no evidence that Airborne works.”

(CSPI also famously called fettuccini alfredo “a heart attack on a plate.” They ruined a lot of Chinese food for me, too, but still, I’d rather know than not. They also offer plenty of what-to-do advice; most often, it steers me away from enticing packaged food and toward as-nature-made-them fruits and vegetables.)

The 40th-birthday issue includes a fascinating rundown of unexpected findings on nutrition over the last 40 years, from the obesity-cancer connection to the exoneration of coffee as a possible cause of pancreatic cancer.

And here’s an interesting Boston-based tidbit from the March issue: There may be a link between high doses of Vitamin C and prostate-related urinary problems such as needing to go too urgently or too frequently, according to data from the Boston Area Community Health Survey.

Bottom line (as Nutrition Actions might say): I trust Nutrition Action as a rare counter-weight to commercial interests. And happy birthday, all.

Daily Rounds: Rethinking Prostate Screening; Medicare Advantage Axed; Urotrauma Emerges; Segway Owner Dies In Fall; POM Deception

Simplifying the Decision for a Prostate Screening – “The findings also suggest that at least half of men who are now screened after age 60 don’t need to be.” (

Harvard Pilgrim cancels Medicare Advantage plan – The Boston Globe “The decision by Wellesley-based Harvard Pilgrim, the state’s second-largest health insurer, was prompted by a freeze in federal reimbursements and a new requirement that insurers offering the kind of product sold by Harvard Pilgrim — a Medicare Advantage private fee for service plan — form a contracted network of doctors who agree to participate for a negotiated amount of money. Under current rules, patients can seek care from any doctor.” (Boston Globe)

Congress asked for study of urological war wounds – Health – Some soldiers returning from Iraq and Afghanistan “are surviving with serious, debilitating injuries to the genitals or urinary system, according to the American Urological Association. The group is concerned that medical personnel may not be properly trained to handle such injuries — known collectively as urotrauma. It wants a national commission to investigate the injuries, find better treatments and design better body armor to protect against roadside bombs.” (MSNBC)

Segway owner dies after falling off river cliff – “The body of 62-year-old Jimi Heselden and a Segway personal transporter were found in the River Wharfe and he was pronounced dead at the scene, West Yorkshire Police said.” (Boston Globe)

Regulators Call Health Claims in Pom Juice Ads Deceptive – “The F.T.C. charged Pom Wonderful, which markets the juice, and the company’s owners, billionaire philanthropists Lynda and Stewart Resnick of Los Angeles, with making false and unsubstantiated claims about the power of their pomegranate elixir.” (The New York Times)