Rethinking Screening for Breast Cancer and Prostate Cancer

Abstract

Population-based screening for prostate and breast cancer has been advocated on the assumption that their early detection and treatment will reduce disease-associated morbidity and mortality. A high proportion of the US population is screened regularly and in the last 2 decades, screening has nearly doubled the detection of early breast and prostate cancer. The overall incidence of both of these tumors has increased substantially and remains higher than prescreening levels. Current screening methods have not resulted in the expected reduction in mortality of either of these tumors. Suggested reasons for the lack of a greater impact on mortality include the following: screening appears to increase the detection of slow-growing early indolent cancers that pose minimal risk. Such tumors are probably cured by surgery alone. Overdetection and overtreatment of such minimal-risk cancers subjects patients unnecessarily to morbidity from adjunct therapy and markedly increase the cost of therapy. Screening also may miss a high proportion of fast-growing aggressive or advanced tumors because they are not screened with sufficient frequency for detection and cure. The authors believe that new diagnostic tests and screening methods must be developed to distinguish between minimal risk and high-risk tumors in order to make a substantial impact on patient survival and reduce the burden of treatment on patients and society.