WINSTON-SALEM — Turning 50 proved to be a milestone for Mike Tyson not just in terms of age.

Tyson, of Winston-Salem, credits the symbolic birthday for saving his life because he chose to undergo a routine prostate-specific antigen test at that time. the test measures a specific protein released by prostate cells.

Because his PSA level was elevated for his age, Tyson underwent a biopsy that revealed prostate cancer. he had surgery in February.

He said his recovery was slow but that in August, he began feeling more like himself, particularly after participating in the Livestrong program for cancer patients and survivors at local YMCAs.

The necessity of the PSA test — and the consequences of what it might reveal — has become a significant topic at local urologist offices since October, when the U.S. Preventive Services Task Force recommended against it.

For men, prostate cancer is second only to skin cancer in frequency of cancer cases. It also is the second leading cause of death, behind lung cancer.

In 2009, health-care lobbying groups criticized the task force for recommending that most women wait until age 50 to get mammograms and then have one every two years. the American Cancer Society’s longstanding recommendation is annual screening starting at 40.

Opponents of the PSA test say it tends to lead to potential misdiagnosis and unnecessary biopsies and treatment for men, particularly for those 50 and older. they say urologists support PSA testing because it can be a significant revenue source.

After conducting five clinical PSA trials, the task force said, “There is moderate or high certainty that the service has no net benefit and that the harms outweigh the benefits.” according to a new York Times report, the task force said the test “cannot tell the difference between cancers that will and will not affect a man during his natural lifetime.”

Proponents point to examples, such as Tyson, as to why the test is pertinent.

Tyson said he’s convinced PSA testing is not only necessary but should be done sooner.

“I had no symptoms of prostate cancer,” Tyson said. “Having my wife die of bone cancer in February 2008 after fighting it valiantly for seven years, and with an 11-year-old daughter to care for, I didn’t consider anything other than surgery.

“If I had gone with the watch-and-wait approach, I might not have been checked for months, if not years, because of being 50. who knows how much the prostate cancer could have spread in that time?”

Urologists affiliated with Forsyth and Wake Forest Baptist medical centers support the stance of the American Urological Association.

“until there is a better widespread test for this potentially devastating disease, the task force — by disparaging the test — is doing a great disservice to the men worldwide who may benefit from the PSA test,” said Dr. Sushil Lacy, president of the association.

“It is our feeling that, when interpreted appropriately, the PSA test provides important information in the diagnosis, pre-treatment staging, or risk assessment and monitoring of prostate cancer patients.”

This issue isn’t one that affects just urologists, said Karen Richardson, a spokeswoman for Wake Forest Baptist. “many men get their prostate cancer screenings from their primary-care physicians,” she said.

Dr. Jeremy Hubbard, a urologist at Carolina Urological Associates, said he disagrees with the task force’s recommendation because it is a sweeping declaration for a decision that is individual in nature.

“We’re concerned that some patients — and some primary physicians — may only consider the task force’s recommendations and not access all the pertinent information they may need,” Hubbard said.

In 2008, the task force recommended against PSA testing in men ages 75 or older, relying instead on the watch-and-wait approach because treating the prostate cancer for men of that age could cause more harm than the disease itself.

Hubbard said that because some prostate cancer is slow to grow, “it requires reasonable active surveillance by physician and patient.”

“Treatment recommendations for someone with prostate cancer are different for someone in their 40s and 50s compared with 60s and 70s,” he said.

The American Council on Science and Health supported the task force’s recommendations because it said tens of thousands of men have had serious complications from unnecessary prostate surgery, ranging from blood in the urine to incontinence and impotence, and even death.

Dr. Gilbert Ross of the council said a more specific test for prostate cancer is needed — one that will identify only cancer cells that are likely to develop into dangerous tumors and metastases.

“the PSA test should not continue to wreak so much havoc on people’s lives,” Ross said.

The Joy to Life Foundation has committed $200,000 to the Alabama Breast and Cervical Early Detection Program so the program can remain open until June 31, the date new funding is expected for the program’s fiscal year.

Joy to Life founder Joy Blondheim of Montgomery said the entire program would have been forced to shut its doors until July if additional funds had not been provided.

“It was totally unacceptable for us that the women in this state with symptoms were going to have to wait until July to get the necessary screenings they needed,” said Blondheim, who made the announcement during a Friday news conference. this contribution is in addition to the funds Joy to Life contributes yearly to the program, she said.

Blondheim started the nonprofit Joy to Life 10 years ago with her husband, Richard, with the aim of providing free mammograms to medically underserved women younger than 50 in 29 counties in south-central Alabama.

The Alabama Breast and Cervical Cancer Early Detection Program provides qualified women with breast and cervical cancer screening at no cost. Women who are screened and diagnosed through this program and diagnosed with breast and/or cervical cancer may be eligible for treatment through Medicaid.

To be eligible for free screening for breast or cervical cancer through the program, women must be a resident of Alabama, age 40 to 64 or uninsured and at or below 200 percent of the federal poverty level, though some women younger than 40 who have abnormal breast exams and women enrolled in Medicare Part A also could be eligible.

For more information on Joy to Life, go to joytolife.org.

– Teri Greene

NEW YORK (Reuters Health) – Screening mammography is less accurate at spotting breast cancer if a woman has had the disease before, according to a new government-funded study.

Breast cancer survivors are more likely to develop new tumors than women without a history of breast cancer, but little is known about screening in this group.

The new results, published in the Journal of the American Medical Association, are based on information from the largest mammography registry in the U.S.

They show screening does help detect breast cancer in survivors, with 7 cancers found per 1,000 screens compared to 4 per 1,000 screens in women who never had the disease.

But the procedure also missed tumors 11 percent more often in the survivors, even though these women had higher numbers of extra x-rays and other radiology tests done after their mammograms.

Survivors were also one percent more likely to be told the mammogram might be showing a cancer, when the woman actually didn't have the disease.

"These findings and additional studies that are likely to be stimulated from this report should lead to improved (radiology routines)" for breast cancer survivors, screening expert Robert a. Smith of the American Cancer Society (ACS) said in a statement.

About one in eight American women will develop breast cancer during their lifetime, but the chance of dying from the disease has been dropping recently and is now less than three percent, according to the ACS.

Experts disagree about when and how often women should get mammograms. The ACS recommends once a year in women 40 and older, while the U.S. Preventive Services Task Force, a federal expert panel, says once every two years in women over 50.

The new study, led by Dr. Les Irwig of the University of Sydney in Australia, was a joint work of American and Australian researchers.

They compared an equal number of screening mammograms — nearly 120,000 altogether — from survivors and comparable women without a history of breast cancer.

Within a year of screening, 655 tumors were found in survivors, compared to 342 in the other women.

Cancers detected by symptoms, and not screening, were more than twice as common in survivors than in the other women.

The ACS's Smith, who was not involved in the study, said the findings underscore the "importance of remaining vigilant about new symptoms and the importance of reporting breast changes immediately" to a doctor.

The authors call for more studies in breast cancer survivors — especially younger ones and those with very dense breasts — as there is no evidence so far that extra screening efforts in these women will improve their survival.

SOURCE: bit.ly/hdrHS9 JAMA/Journal of the American Medical Association, online February 22, 2011.

Dr Vichien Srimuninnimit of Siriraj Hospital’s Medical Oncology Division said the goal of cancer screening was to find pre-cancerous lesions and cancer before symptoms appear, which can help patients access treatment, but some screening tests such as colonoscopy can cause serious problems.

As well, some tests can show false-positive results, which cause patient anxiety and unnecessary invasive diagnostic procedures, which also entail risks and cost. Conversely, a false-negative result can lead to a delay in seeking medical care even if there are genuine symptoms.

“Finding cancer may not improve the person’s health or help the person live longer,” Vichien said.

He was speaking at the second annual “Cancer Prevention, Early Detection and Interception” conference organised by Chulabhorn Hospital, participated in by 360 cancer researchers nationwide.

“Some cancers never cause symptoms or become life-threatening, but if found by a screening test, the cancer may be treated. also, treatments for cancer have side effects,” he pointed out.

Screening tests for breast, cervical, colon, prostate, lung and ovarian cancer are mostly available at private hospitals.

Citing the American Cancer Society (ACS) guideline for breast-cancer screening, Vichien said yearly mammograms should start at age 40 and continue for as long as a woman is in good health.

Clinical breast exams should be undertaken about every three years by women in their 20s and 30s and every year for woman 40 and over. Meanwhile, breast self-examination is an option for women starting in their 20s.

But the US Preventive Services Task Force has recommended that mammography screening should be conducted every two years to reduce risk of breast cancer by nearly half. Moreover, the USPSTF has suggested that doctors not teach women to perform breast self-examination, as it has been found to have no mortality benefit.

The ACS also recommended that asymptomatic men who have at least a 10-year life expectancy have an opportunity to make an informed decision with their healthcare provider about whether to be screened for prostate cancer, after receiving information about the uncertainties, risk and potential benefits associated with screening for that disease.

Despite the high cost and limited benefit of screening, it should be done for men with family history of prostate cancer.

However, Vichien said screening should be done for diseases that are important health problems and for which there is a detectable pre-clinical phase.

A cancer-screening method should be accepted as standard care only when its value has been demonstrated in randomised controlled trials, he said.