On this blog I have tried to be minimally involved in writing about the PSA screening controversy, but I find it is getting hard to continue to avoid the issue. As I ate my breakfast this morning I was reading the New York Times and came upon the article “Quandary with Mammograms: Get a Screening, or Just Skip It?” written by Denise Grady. As I read it, my blood pressure started to climb (not a good idea for any of us).

As you probably guessed, Brady was writing about making a personal decision about having a mammogram. Like PSA tests for men, the efficacy of mammograms have been called into serious question. Doctors claim that mammograms, like PSA testing, brings about more harm than good by causing over treatment for cancers that will never become significant.

To set the record straight, neither PSA testing or mammograms cause over treatment; poor counseling, poor advice from doctors and their greed causes over treatment. In reality these are the issues that need addressing, not ending screening. People are entitled to know about their physical status and then receive good, solid and appropriate advice from their doctors about what treatment is appropriate, if any.

Even though the issues between PSA testing and mammograms are exactly the same doctors, the American Cancer Society (ACS) and our government are all guilty of following the money and the political winds. Last month, Dr. Otis Brawley, Medical Director of the ACS and chief opponent of men and PSA testing, issued a very clear statement that the medical profession has over stated the benefits of cancer screening. He even said that if a woman chose not to have a mammogram he would “not think badly of her.”

In response to and with a concern about the economic repercussions of not supporting women and mammograms, the ACS issued another, contradictory to the evidence and Dr. Brawley’s statement, saying that all women over 40 years should have a mammogram every year. However, the statement also said, “Mammograms can miss cancers that need treatment, and in some cases find disease that does not need treatment.” This statement sounds very familiar; it is the exact statement they had issued about PSA but they did not recommend that men have a PSA test!

Under our current system, both PSA testing and mammograms do lead to over diagnosis and over treatment. They both cause many people to suffer unnecessary hardships and pain. Gradey added that some researchers believe that as many as one-third of breast cancers picked up by mammograms would not be fatal if left untreated, yet they are still treated.

She discussed this issue with a number of experts all of who told her “mammograms were still important …. After all, breast cancer still kills 40,000 women a year in this country.”

Therefore, for me the writing is clear, our society does not equally value the life of its men to its women. We will eventually work through the newspaper articles, journal papers and the TV reports that continue to recommend that woman get their annual mammograms, but men not be given PSA tests. Nowhere have I read an acknowledgment that PSA tests are important … after all, prostate cancer kills 30,000 men in a year in this country. 30,000 men do not equal 40,000 women, but it is a hell of a lot of people to just ignore.

I do want to make one thing very clear, I am not against women having mammograms, I am against men not being given the same quality of care because they have been socially inept and not figured out how to organize themselves the way the women have been able.

On the side, I also want to point out how good the women’s public relations machine really is, we never talk about men with breast cancer, all the conversations are about women, but men also get breast cancer.

Joel T Nowak, MA, MSW