But loss of personal choice is not an issue for women only. Look at PSAs. As the pioneering prostate cancer surgeon Patrick Walsh of Johns Hopkins points out, a European randomized trial showed that PSAs saved lives. In the United States, there has been a 40 percent reduction in prostate cancer deaths since testing began in the early 1990s. Yet prostate screening arouses many of the same concerns as does breast cancer screening: too many follow-on studies, too many biopsies, and surgery on slow-growing tumors that may never have harmed the patient. The government task force claims that there's insufficient evidence to make a recommendation for routine screening of men younger than 75 and is firmly against screening in men older than that. The American Urological Association's position is the polar opposite: Baseline PSAs should be offered to men at age 40, and the frequency of subsequent testing should be determined by doctor and patient choice.
With all the disparagements of screening, Walsh worries about the future for men who would have benefited by early attention. "Who is going to be their advocate?" he asks. As things are going, doctors might be losing the ability to play that role—a healthcare transformation that to me would be a tragedy.
[Related slide show: 11 Screening Tests You Should (and Shouldn't) Consider]