Copyright 1999 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.
To the Editor: The timely update by Dr Stern and colleagues1 on emerging issues in early detection of prostate and colorectal cancers raised many important points, some of which require clarification and emphasis.
The American Cancer Society (ACS) recognizes that there exist differing opinions as to whether early detection testing for prostate cancer lowers disease-specific mortality. Our updated guidelines of June 1997 advise physicians and other clinicians to offer early-detection testing for prostate cancer to appropriate patients and to provide information to patients on the test's potential risks and benefits.2 The casual reader of the article by Stern et al might erroneously construe that ACS supports "mass" screening.
Studies have shown that, when men are provided with more formal information regarding early-detection testing for prostate cancer, many decline it.3 The ACS is concerned that men may be undergoing screening without proper pretest guidance and education and agree that routine serum prostate-specific antigen (PSA) measurement is not appropriate without such education. As is the case with testing for the human immunodeficiency virus, serum PSA measurements should not be bundled in among other routine blood studies that do not require any preamble discussion.
The ACS is also concerned that clinicians who do not let men know early-detection testing for prostate cancer is available vitiate a man's right to choose to undergo a relatively simple test that could conceivably save his life.
In summary, ACS is not telling men to be tested or not to be tested. We simply believe that men should be offered the option of making an informed decision for themselves given the potential importance of testing.
In contrast to prostate cancer, early-detection testing for colorectal cancer has been definitively proven to consistently lower disease-specific mortality in several large trials, yet most Americans have not been screened for colorectal cancer.4 Colorectal cancer is likely the No. 1 cause of cancer death in the millions of Americans who have never used tobacco. Early-detection testing for colorectal cancer is arguably the most powerful, underused lifesaving examination available in the United States today.
Finally, recent studies suggest that every patient older than 50 years with any recent rectal bleeding, constipation, or diarrhea should be advised to have total colonic evaluation to rule out colorectal cancer.5 - 6 Clinicians must remember to take a detailed family history and a thorough review of lower gastrointestinal tract symptoms to identify highest-risk Americans most likely to benefit from early detection and diagnostic testing for colorectal cancer.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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