Prostate

Sometimes referred to as the prostrate which is fine since the prostrate position protects the prostate.  Anyway,  there's a new twist in the marketing for this much maligned little organ.

Cancer prevention through a pill!   Woohoo!   What can possibly go wrong?

http://www.msnbc.msn.com/id/36123806/ns/health-cancer/

This is the craziest headline ever.  

Heart failure risk linked to prostate drug

FDA recently approved Avodart as a cancer preventive medication for men

I have a copy of the study they're referring to in the article.   They took men with elevated PSA tests and a set of negative prostate biopsies and labelled them high risk.  These men were then placed on a prostate shrinking drug called Avodart or a placebo.  They had another set of biopsies at 2 years and at 4 years.  

There were more men with a positive biopsy for cancer at both 2 and 4 years in the placebo group.  

Turns out that 70% of the benefit was in slow growing cancers.   You can try and predict which cancers are slow growing and unlikely to spread and those which are fast growing based on how abnormal the cells look under the microscope,  it's called a Gleason's score.  Most of the benefit was in preventing or delaying or masking the more benign cancers.  When men are diagnosed with the slow growing prostate cancers there's a lot of treatment options including "watchful waiting".   Where you can tell a man that his cancer is so slow growing that we can't make you any healthier treating it with radiation or surgery only harm you.  

Well what about the cancers that have already spread did Avodart prevent them?   No sir,  there weren't any like that found in this study.

What about the more aggressive looking ones on the biopsy,  with a high Gleason's score?  

Well the highest scores the last 2 years of the study were found more often in the Avodart group.   And of the most aggressive looking cancers found on biopsy those last 2 years of the study,  14 were in the Avodart group and 1 in the placebo group.  

So what will happen is this "prevention" will be applied to all men with a high PSA or with a family history or certain races.  Sure looks like it might be causing aggressive prostate cancers and why are we trying to use a "prevention" when the PSA test has been proven to harm about 48 men for every 1 it saves?

Don't get me started on the rate of side effects 

http://www.philly.com/philly/news/homepage/89666907.html

National Breast Cancer Coalition

Sometimes I hear that there are no breast cancer advocacy groups who question the benefits of screening mammography.   Well here's a rather large one:


The National Breast Cancer Coalition (NBCC)* is a powerful voice, speaking for women and men across the country, demanding victory in the war against breast cancer. In 2003 it was named one of the twenty most influential groups in health policy based on a survey of congressional staff-the only grassroots group and the only breast cancer organization to make that list.


NBCC has grown to include hundreds of organizations, representing several million patients, professionals, women, their families and friends. Coalition members include cancer support, information and service groups, as well as women's health and provider organizations.




Check out what they have to say about the recent Preventive Task Force Services screening mammography recommendations 

http://www.stopbreastcancer.org/index.php?option=com_content&task=view&id=978&Itemid=179


And this

http://www.stopbreastcancer.org//index.php?option=com_content&task=view&id=976&Itemid=179

To Overhaul the System, ‘Health’ Needs Redefining

http://www.nytimes.com/2009/07/28/health/views/28essa.html?partner=rss&emc=rss

Great Essay 

ends with:

If you are one of the millions of Americans adversely affected by the unrelenting growth of health costs — an employer that can’t afford insurance or a patient who can’t afford prescription drugs or can’t find insurance at all — you have to take back responsibility for deciding what health really means, not surrender that decision to “experts” with strong financial incentives.

And even if you are one of the few who doesn’t need to worry about money, you still need to take back this responsibility. Your health may depend on it.