Earlier this month the American Cancer Society published its annual predictions for 2020 cancer deaths and new cases; they have been doing this annually since the early 50’s. ACS made a big deal about how deaths have fallen, especially from 2016 to 2017 when they dropped by 2%. 2020, by the way, shows almost no change in aggregate mortalities, 606,880 down a tad to 606,520; diagnoses increase from 1,762,450 to 1,806,590. The press played up the 26% decrease in the ‘death rate’ over the decade – the death rate is the number of deaths per ‘000. They cited decreases in the four major cancer killers that includes prostate cancer and as well as lung, colorectal and breast. And the ACS release smoothlessly segued into moving the comparison to actual deaths ….. so lets talk actual numbers.
Prostate cancer deaths predicted by ACS for 2011 were 33,720; in 2020 they suggest 33,330; however new PC cases for PCa do fall from 240,890 to 191,930 in 2020. And before I make your head do a Triple Axel Lutz, just one more set of numbers – the nadir ( a word most living with PCa readily recognize, but for those who do not, it means the ‘low point’) for deaths came in 2016 at 26,120 and for diagnoses in 2017 with 161,360. Oh – one last thing for PCa that will become relevant in the next paragraph ….. deaths are predicted to increase 5% and diagnoses by 10% this year over last.
Why is PCa bucking the trend? Well Prostate Cancer Foundation appears offended by the recent numbers, and would you like you know it has nothing to do with their efforts ….. I am not so sure. Their blog post last week suggests many of us are misinterpreting the data and offers 7 reasons why – you can read them for yourself here. I would suggest that perhaps PCF are overlooking some very important facts and would like you to bear them in mind when you read the PCF blog piece.
First, PCF claims the ACS 2020 numbers are predictions based on a model …. TRUE, but PCF has frequently cited and relied on these numbers to argue its case in the past.
Second, PCF refers us to the death rate rather than the absolute numbers. They fail to point out that many PCa deaths are not correctly attributed on the death certificate. If AnCan has the chance to work with a family post-death, we ask them to ensure PCa is cited as the cause. This can get complicated as primary and secondary causes are recorded. It requires an epidemiologist to tell us what the PCa death rate numbers employ. In other words, none of the numbers are that reliable and we should be looking at trends not the miniscule changes in the death rate PCF cites..
Third and most significantly, nowhere does PCF address the distortions caused by the USPSTF recommendations to stop PSA testing first issued back in 2012 and clearly reflected in the ACS numbers over the past decade. While PCF is occupied excusing their responsibility – at least that is how I read their blog post – they fail to mention who was responsible. The fault should clearly be laid at USPSTF’s doorstep as a direct result of their 2012 recommendation not to PSA test. Prostate cancer is largely asymptomatic until so far advanced that it is incurable. If you don’t screen, you cannot diagnose – no wonder diagnoses declined about one-third from 2011 to 2016! Now what happens is that men are diagnosed with advanced disease – and studies have confirmed this. About 5 years after metastatic diagnosis, prostate specific death all too often occurs ….. and yup, we see that in the numbers. Btw, PCF’s highly influential voice was not that loud in 2011 and 2012.
At the time, the voice of AnCan’s principals were loud. We predicted that in years to come diagnoses would fall, and soon therafter deaths would rise. …. and that is exactly what is now reflected. Fortunately, diagnoses are once again increasing, most likely attributable to the USPSTF relaxing its recommendtion in 2016 and 2018. But we still see deaths increasing as many men are now diagnosed symptomatic with incurable, metastatic disease ….. and too many of these men are way younger than they should be. Don’t be surprised if deaths top 40,000 before long!
So one lesson to learn from this …. PSA testing is about information NOT treatment.! And if you don’t test, you don’t know. If AnCan had a dime for every man we counseled over the past decade +, diagnosed with worse disease as a result of failing to do routine annual PSA tests (myself included because my GP did not believe in PSA testing), we would be able to pay salaries ….. just sayin’!