In 2004, a group of 30 men in Melbourne, Australia organized an event to raise funds for prostate cancer research. They grew their best Tom Selleck moustache for the entire month to pay tribute to this important medical issue.
Little did they know that their well-intentioned small event would balloon into a multi-million dollar corporate fund raising giant.
How relevant is prostate cancer in men?
According to the cancer research society, prostate cancer accounts for 14% of all cancers and cancer accounts for about 30% of deaths in our country. It would appear that prostate cancer is a highly relevant issue.
This statistic must be looked at with a narrower lens however. It is not correct to assume that a diagnosis of prostate cancer will become the cause of death in that person.
In fact, it is well known in medical circles that most men die with prostate cancer, not of it.
Despite a steady increase in the number of diagnoses over the past 20 years, deaths from prostate cancer have stayed quite stable. Although oncologists would boast that improved cancer care accounts for the stable death rate – I would counter that an aggressive increase in screening programs have been detecting more non-fatal cancers in men.
Screening sounds like a good idea. Should we not be bolstering efforts for this life saving cause?
Screening does sound like a logical concept when presented correctly. After all, how are we supposed to find cancer if we do not try to detect it.
In the case of prostate cancer, screening has been particularly muddy. The strong recommendation of the PSA test has certainly ignited experts. They know that the test is riddled with false positives, which has lead to unnecessary testing.
It is undeniable that the introduction of PSA testing has dramatically increased the number of prostate biopsies. Once a biopsy is done, one can often go down the rabbit hole of post-operative complications, repeat biopsies to follow up on indeterminate findings, and so on.
When the dust settles, the ultimate effect of our current strategy has been:
- An enormous increase in PSA testing
- A dramatic increase in prostate biopsies
- A small increase in prostate cancer diagnosis
- No decrease in mortality
I’m not saying that we should have no screening method in place, but the current one is not proving to be effective. I for one can not advocate further pumping of money into a defective process. I would certainly feel more enthused if I saw signs of the system moving a different direction.
If we don’t put our money into screening, then where should it be spent?
To put this into perspective, here are some words that come to mind when I think of our current prostate cancer strategy:
- PSA blood test
- Digital rectal examination
The average reader can see that such modalities are used to find and treat cancers … NOT prevent them.
The reality of cancer care today is that the majority of efforts and funding is funnelled towards screening and treatment. In Khalid Mahmud’s book called ‘Keeping Abreast’, this oncologist tells his life story of sitting on the breast cancer federal task force for over 10 years. He reveals that 98% of funding is put towards screening and treatment, while 2% is allotted to prevention.
Although detecting and treating cancers is important, the fundamental nature of this system is incapable of actually curing cancer. The design of this system is to find and treat more cancers.
This concept is also consistent with the fact that diagnosis of most cancers have trended upwards over the decades.
The cure is in prevention
The only way that we can actually cure cancer is to change the way the medical system researches cancer.
This would involve a shift in attention from a detection system towards a preventative one.
The Movember I would support would spark thoughts such as:
- Deciphering the link between environment and cancer
- Learning the role of estrogens and hormones in the development of prostate and breast cancer
- Promoting healthy dietary advice to reduce cancer risk
- Examining how our detoxification systems affect cancer risk
- What are we doing about industries who are flooding the market with carcinogenic products
The list could go on and on, but you can see that if all of the right questions are being asked and addressed, you might just be on your way to solving the mystery of cancer.
I won’t grow my moustache this year, but I will continue to support a lifetime of curing diseases through prevention.
Dr. Rishi Verma, MD
Latest posts by Dr. Rishi Verma, MD (see all)
- Dr. Verma attending thought leaders consortium in Phoenix. October 19, 2016 - October 17, 2016
- Dr. Verma speaking at Choices Market on Revolutionizing your Healthcare - April 22, 2015
- Dr. Verma Featured on CKNW News on January 31, 2015 - January 29, 2015