Here's a number to sit with. A review of 29 autopsy studies estimated that nearly 60% of men aged 80 or older had prostate cancer. They never knew they had it. Rich Danker, a former assistant secretary of Health and Human Services, put that figure in a letter to the Journal on Wednesday. His point is one we've made before. Finding a cancer has costs you can't see.
The letter answers two Journal editorials. One criticized the U.S. Preventive Services Task Force for its 2012 decision to recommend against PSA screening for prostate cancer. The other argued that Iowa's rising cancer counts come from more screening rather than from farm chemicals. Danker says the second editorial's insight was missing from the first. “More men die with prostate cancer than from it,” he writes, whether they knew it or not.
His Iowa evidence is simple. The state ranks near the top in new cancer cases. Its cancer death rate sits about at the national average. Screen more people, he argues, and you find more slow tumors that might never have done harm. That's a likelier explanation than nitrates and pesticides. He wants overdiagnosis weighed the same way when the government reviews any cancer screening.
The panel that decides
The task force matters for your wallet. We wrote on Oct. 16 about how this obscure panel decides which screenings insurers must cover for free. Danker notes it's staffed by primary-care doctors who weigh screenings for patients, rather than by the specialists who do the procedures. He says its caution has lost to pressure before. In 2009 it advised starting routine mammograms at 50 instead of 40. Congress and the administration at the time kept that from touching coverage rules. More recently, he says, it approved colonoscopies for younger people in response to rising case counts rather than trial evidence.
Our read
This is Health Costs, and it's a question of what a test is for. A screening test is only useful if the result would change what you do. For a man of 80, a prostate finding often changes little for the better. It can start biopsies, scans, treatment and side effects for a cancer that was going to sit quietly. It can also start a bill. Each step after a positive test has a copay, and a positive test on one thing tends to lead to tests on other things. Medicare pays for a lot of it, and nothing covers the worry. So ask the doctor one thing before any screening. Ask what you'd do differently if it came back positive, and whether that would likely help you live longer or better. If the honest answer is nothing, the test can wait. That's a conversation with your doctor, and we're not the ones to make the call.
The one thing in your plan this touches is the health-cost line for your eighties. The money part of a long life is mostly medical, and some of it is optional. The check this week is a look at your next physical. If a screening is on the list, ask ahead of time what a positive result would change. Write the answer down and bring it to your review. The time to check the roof is before the clouds, and the same goes for a test.