By Michael J. Katin, MD
It seems like only yesterday that the oncology community was eagerly awaiting the major event of the year. And then only two days after the opening of Star Wars: Episode II began the 38th Annual Meeting of the American Society of Clinical Oncology.
Unlike many other years, the media were preoccupied by other stories (the risk of nuclear war in the Asian subcontinent, the fluctuations in the domestic economic picture, the Winona Ryder trial) and coverage of the ASCO meeting seemed dramatically reduced from usual. I'm sure there must have been more than the two items that I heard on AM radio news programs, but maybe not. These two articles dramatized a commonly seen schizoid attitude regarding health care.
Parenthetically, the term "health care" has always been a mystery in itself. Over the past fifty years the favorable spin has been put on medical facilities to the point that no "infirmaries" are being built, only "health centers." Perhaps this is is the same as having the "fire" department extinguish rather than set fires (except in Fahrenheit 451) or having the "Justice" Department investigate criminal rather than righteous acts.
For some reason, the news gods decided that it was worth reporting preliminary results with ZD1839 as if this were a major breakthrough in cancer care (another example....are we taking care of the cancer or trying to get rid of it?) and many of us spent the next several weeks explaining to our patients that this compound had been known to us for many months and that our medical oncology colleagues in our own community had probably been obtaining it for their patients on study and on the compassionate use program for nearly that long, and it was not due to our ignorance or lack of caring that we were not giving this to everyone, regardless of the fact that it had never cured anybody and usually worked only in combination with chemotherapy. The news articles also failed to mention the potential pricetag, but how can you put a price on human lives?
Until the next day, when the news reported that PSA screening was being done much too frequently, resulting in unnecessary expense and anxiety. For the few people who may have missed hearing about this, the conclusion in most of the articles was that doing the PSA test every five years would be adequate if one started with a low reading initially. This was a summary of a presentation on May 20 by E. David Crawford at the ASCO meeting in Orlando. It may have been questioned that, with the meeting being in Orlando, whether this was being presented in Frontierland, Tomorrowland, or Fantasyland. This comes after years of effort to make men aware of the risk of prostate cancer, with the American Cancer Society, among others, recommending annual PSA testing and digital rectal examination for all men over 50, and even as young as over 45 if African-American or in men with a father or brother with prostate cancer.
Needless to say, this has now created a great deal of controversy and, if coverage of the Michael Skakel trial and the FBI/CIA hearings hadn't dominated the news, undoubtedly there would have been articles dealing with this controversy. It may even be a mission worthy of Matt Drudge to find out why the ASCO website's summary of the meeting states that "E. David Crawford, MD, presented a study that suggested shorter intervals for PSA screening." Regardless of how this report was intended to be received, and which of these conclusions is valid, Pandora's can of worms has now been opened regarding screening.
Was it six months ago or longer that the question of the value of mammography was stirred up once again? Fortunately, the use of mammograms probably will be obsolete shortly due to the development of the cancer-scanning bra, working on the principle that normal tissue and tumor tissue have different resistance to electric current. This device should rapidly gain acceptance, since it eliminates exposure to x-rays and also can be used as a protective device for dating (set on "stun"). It may be a matter of time before a similar apparatus is used to detect prostate cancer, although I will defer details to your imagination.
But for now, the question of the value of PSA screening will need to be settled based on the data collected from the study reported at ASCO. Although this time we're asking Arthur Andersen to look at the numbers.