Ask The Doctor

Don’t Skip PSAs and Breast Exams

Dear Dr. Garner

My husband and I are totally confused with the changes in when to get mammograms and PSAs. We have been diligent about the tests, but now hear they’re no longer recommended. 

What is your opinion?

Confused Couple
In Canarsie

Dear Confused,

You are not the only ones confused. Many doctors feel the same way.

The confusion is the result of two government task forces. One reviewed mammograms and the other reviewed the PSA test, which detects a chemical in the blood that may increase with prostate cancer.

Their conclusions have caused much angst in the medical community, as well as the public in general.

First let me address the PSA changes that were recommended last week.  I was just discussing them with my good friend and loyal Tablet reader, Dr. Antonio Mascatello.

The panel recommended that routine screening with the blood test for PSA, no longer be performed.   They felt that the test caused useless anxiety among men. They argued that many men have prostate cancer and never die from it, because it grows slowly.

They also noted that due to the PSA test results, men were subjected to biopsies and treatment that often left them incontinent and impotent.

I totally disagree with this recommendation. The PSA has been shown to save lives in several large studies.  The test allows a man to be proactive about his health. The key to success in having the exam is to do it in conjunction with a doctor you trust. PSA may be high in cases where there is a benign condition, such as an enlarged prostate, constipation and infections.  The result must be carefully evaluated to ensure that the patient is fully informed of options available.

It is true that prostate cancer can be aggressive, or may never cause a patient any harm. This is why many doctors merely follow the patient without doing any further tests or work-up.

I think most men would like to have an idea of the functioning of their prostate gland, rather than to be totally in the dark about possible early cancers.

Let us not kill a test which may save thousands of lives, just because there is confusion in interpreting the result. Hopefully, we will have more accurate tests as time goes by, but at the present, at least this one, non-invasive blood test is available to provide an early warning signal for men to protect against this disease. Have your husband follow up with his doctor to determine what is best for him. There is no one size fits all approach to prostate health.

As far as mammograms, there is no doubt in anyone’s mind that mammograms save lives. The government committee argued in its report that there were false results from the mammograms, which subjected a women to unnecessary biopsies and possible harmful effects.

I could not disagree more with their conclusion that women between the ages of 40-50 should not get routine yearly mammograms. Breast cancer for women in their 40s tends to be more aggressive than in older patients.  Why would we not want to discover these cancers as early as possible?

Recent studies from Sweden have shown a significant drop in deaths from breast cancer with routine screening of women in their 40s.

The American Cancer Society and the American College of Radiology continue to recommend mammograms beginning at age 40, and then yearly.  It is important to check with your doctor, as the screening should be tailored to one’s family history. If there is a strong history of breast cancer (mother or sister) then the screening may begin even earlier and may include tests such as an MRI, that not everyone will require.

The committee also recommended against self-breast exam. Again, I strongly disagree. The self-breast exam allows a woman to become familiar with her breasts and makes her a partner in the health care process. We have seen many cancers detected through self exams, which, if not performed, would have delayed diagnosis and possibly reduced chances for full recovery.[hr] Dr. Steven Garner is a Fidelis Care provider who is affiliated with New York Methodist Hospital, Park Slope. He also hosts “Ask the Doctor” on NET, Tuesdays at 8 p.m. on Ch. 97 Time Warner and Ch. 30 Cablevision.

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