Katie Couric, Rosie O'Donnell and Norman Schwarzkopf have all appeared on television delivering emotional pleas urging people to get screened for various types of cancer. But these public service announcements may be doing more harm than good, a new medical study claims.
In one television message, former New York Mayor Rudy Giuliani encourages people to get the prostate specific antigen, or PSA, test. "Of course, we probably wouldn't be talking about this if I hadn't gotten screened...." he says. "If you're over 50 or in a high-risk group, please get screened -- now."
Celebrity-driven messages work, according to the study published in the May 4 issue of the Journal of the National Cancer Institute. More than half of adults surveyed by phone had seen or heard celebrity cancer-screening endorsements, and more than one-fourth said the appeals made them more likely to get screened.
But the researchers who performed the study say that's not necessarily a good thing. Getting screened for colon, prostate or breast cancer is certainly the right thing to do for some people. But for others, an inappropriate diagnosis can subject patients to unnecessary and invasive treatments and tests, as well as emotional strain.
"The celebrity endorsement oversimplifies what is a complex decision that has pluses and minuses and no obvious answer," said Dr. H. Gilbert Welch, a co-author of the paper and an internist at the Department of Veterans Affairs medical center in White River Junction, Vermont. "But the celebrity endorsement makes it seem as if it were a no-brainer."
Counterintuitive as it may sound, it's sometimes better not to find out about cancer, the researchers said. Some cancers are likely to resolve themselves without treatment, and some patients may be likely to die of another ailment before cancer becomes an issue. A third reason for patients to be wary of cancer screenings is that the risk of false positives seems to increase with more screenings.
Overdiagnosis, particularly of prostate cancer, is an increasing problem that celebrity endorsements could be exacerbating, the researchers said.
The U.S. Preventive Services Task Force and other organizations have recently updated their guidelines to reflect increasing uncertainty over best screening times. Instead of assuming they have a responsibility to be screened, patients should discuss the pros and cons of screening with their doctor, the authors said.
"It's not a simple decision to make," said Robin Larson, co-author of the study and internist at the VA medical center. "We think an informed, balanced discussion is what's needed."
British researchers have found evidence that breast cancer could be a candidate for overdiagnosis, and other studies have suggested it can happen with lung cancer and neuroblastoma in children.
Whether cancer overdiagnosis is truly a problem remains controversial. Unfortunately, scientists have not yet found a test that will determine which cancers -- if any -- are best left untreated.
The authors said it is entirely appropriate for celebrities to promote good health or discourage behavior risky to others, like drunken driving or unsafe sex.
"However, when it comes to communicating about complex decisions such as cancer screening, the goal should not be to persuade but to inform," the authors wrote. "Thus, we see no obvious role for celebrity endorsement of cancer screening."
But other oncologists said efforts to persuade patients to talk about screening with their doctors should be encouraged.
"Anybody or anything that helps us get people to do that is a good thing, and we need all the help we can get," said Dr. Peter Paul Yu, president of the Association of Northern California Oncologists and an oncologist in Sunnyvale, California. "So I think having celebrities contribute to that is a great thing."
Yu conceded different screening recommendations can be confusing to patients. The recommendations for breast cancer, for example, vary for the American Cancer Society, the Cleveland Clinic and the National Cancer Institute. But celebrities can help people overcome their fear of even discussing a screening, he said.
"(Screening recommendations) need to be applied to each individual patient," he said. "It's not a cookie-cutter formula. But it's better to have the conversation in the right setting. I'm just interested in getting the patient in here."
