Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Executive Deputy EditorIndividualAuthor
In Reply: Mr Donnelly argues that prostate
cancer screening is effective. Given all the men who have been exposed to
multiple diagnostic and therapeutic procedures, we certainly hope this is
true. Unfortunately, no one knows.
What we do know is this: there is no cancer with a more dramatic change
in 5-year survival than prostate cancer, for which survival rates have increased
from about 40% in the 1950s to about 95% currently. While it is tempting to
conclude that medical treatment has made major advances, the fact is that
prostate cancer has about the most stable mortality rate (21.6 per 100,000
in 1950, 21.0 per 100,000 in 1973, and 22.5 per 100,000 in 1997) of all major
cancers.1 Prostate cancer exemplifies our
basic point: changes in 5-year survival overstate progress against cancer.
Using 5-year survival to make judgments about screening will always lead to
the conclusion that screening is effective.
Welch HG, Schwartz LM, Woloshin S. Do Increased 5-Year Survival Rates in Prostate Cancer Indicate Better Outcomes?—Reply. JAMA. 2000;284(16):2053-2055. doi:10.1001/jama.284.16.2053