Outdated guidelines putting lives at risk
If there was a possibility that you had an illness that could ultimately kill you, why wouldn’t you want to know as early as possible?
I’ve asked myself that question several times over the past year, as I work through the impact of having prostate cancer.
I’ve written about this before, but about a decade ago my doctor and I discussed whether I should be getting regular PSA tests. The prostate- specific antigen (PSA) test is a blood test that measures the presence of that antigen in the bloodstream. In almost all cases of prostate cancer, there is an elevated PSA level.
My doctor ordered a PSA test, and my level was within the normal range for my age.
Based on that result, the fact that I had no family history nor symptoms of prostate cancer, and media reports that suggested that PSA tests may result in false positives, we agreed to not continue regular testing for PSA.
A decade later, I asked my new doctor to have my blood tested for my PSA level, and the number was very high for my age. I was referred to a urologist in Winnipeg, who ordered another PSA test. The number from that test was just as high. He then ordered a biopsy and, a few weeks later, I was told that I had an aggressive form of prostate cancer.
He also told me that, if I had not had the PSA test when I did — if the cancer had not been diagnosed because of that test — I would have likely been dead within two years.
After going through a series of diagnostic tests last summer to determine if the cancer had spread to other areas of my body — it hadn’t — my prostate was removed in September. If the cancer had spread beyond the prostate, I would not have been eligible for surgery and would probably be pre-planning my funeral right now.
I am still in the process of recovering from that surgery, and am undergoing regular diagnostic tests to determine if I am cancer-free. The results are encouraging so far.
I say all of that in order to explain the frustration I felt as I read a Canadian Press report in Wednesday’s Sun, entitled “Cancer Screening Delaying Diagnosis: Doctors.”
The report indicated that a group of Canadian doctors are concerned that cancer screening guidelines set by a national task force are putting people at risk because their cancers aren’t being detected early enough.
Dr. Fred Saad, a urological oncologist and director of prostate cancer research at the Montreal Cancer Institute, said in the report that “I’m faced with treating too many patients dying of prostate cancer on a daily basis due to delayed diagnosis.”
The Canadian Task Force on Preventive Health Care sets clinical guidelines to help family doctors and nurse practitioners decide whether and when to recommend screening and other prevention and early detection measures to their patients.
Dr. Saad and other doctors associated with the Coalition for Responsible Healthcare Guidelines contend that the task force’s screening guidelines for breast, prostate, lung and cervical cancer are largely based on older research and conflict with the opinions of specialists in those areas.
For example, he says that the task force’s recommendation against PSA testing for men who haven’t already had prostate cancer — based on the possibility of false positive results potentially leading to unnecessary biopsies and treatment — is “outdated” and “overly simplistic.”
Dr. Eddy Lang, a member of the task force, says that the harms of false positives should not be underestimated, but Dr. Martin Yaffe, co-director of the Imaging Research Program at the Ontario Institute for Cancer Research, argues that the task force places too much emphasis on the potential harm of possible false positive test results.
He says that “It’s very hard for us and for patients to balance this idea of being called back and being anxious transiently for a few days while things are sorted out, compared to the chance of having cancer go undetected and you end up either dying from it or being treated for very advanced disease.”
Based on my own experience, I agree with Dr. Yaffe. I should never have let the possibility of a false positive PSA test result (which I now know would been detected by a second PSA test in any event) prevent me from getting the test for an entire decade.
It was a dangerous decision, based on the existing guidelines, and it almost cost me my life.
We are repeatedly told that early detection is critical to winning the fight against cancer. Given that fact, why wouldn’t the task force promote guidelines that encourage early detection?
The possibility of false positives is a weak excuse. Is cost-cutting a greater reason?
Even more importantly, don’t patients have a role to play in deciding whether to be tested? By creating guidelines that delay testing, is the task force gambling with the lives of Canadians without the informed consent of those patients?
That brings us back to the original question: If there was a possibility you had an illness that could ultimately kill you, wouldn’t you want to know as early as possible?
If your answer is yes, I encourage you to have a frank discussion with your doctor about early testing and whether the current guidelines are appropriate for you.
That chat could save your life.
Deveryn Ross
Deveryn Ross is a political commentator living in Brandon.
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