Detection of latent prostate cancer from routine screening: comparison with breast cancer screening.

OBJECTIVES

One criticism of routine prostate cancer screening is the possibility that latent prostate cancer would be detected and treated in men who would otherwise never need treatment for their prostate cancer. This increase in latent cancer detection with screening could lead to overtreatment, with its resulting increases in morbidity, mortality, and health care costs. In contrast, breast cancer screening is widely accepted, and there is little concern about latent breast cancer detection and overtreatment of breast cancer due to screening. This study compares the detection of latent prostate cancer from screening with the detection of latent cancer in an established cancer screening program (breast cancer screening) and examines the risk that screening leads to an increase in detection of latent cancer over traditional methods of detection for both breast and prostate cancer.

METHODS

The present study reviews outcomes data from several large prostate and breast cancer screening trials. The natural history of latent prostate and breast cancer is then reviewed. By applying this information, the rate of latent prostate cancer detection and latent breast cancer detection with screening is compared.

RESULTS

Recent large-scale prostate cancer screening studies have reported a latent cancer detection rate of 2.9% to 8.0%. This rate of detection is virtually the same as that found by traditional methods of detection. Ductal carcinoma in situ (DCIS) is a noninvasive breast cancer that accounts for 16.2% to 23.7% of breast cancers detected in screening programs using mammography. The literature estimates that DCIS will remain latent in 50% to 66% of patients. These data suggest that the latent breast cancer detection rate in screening programs is 8.1% to 15.6%, which is a threefold to fivefold increase compared with the detection rate of latent breast cancer prior to screening with mammography.

CONCLUSIONS

These results suggest that the latent prostate cancer detection rate from screening is similar to or less than the latent breast cancer detection rate from screening. Furthermore, prostate cancer screening does not appear to increase the detection rate of latent cancer over traditional methods of detection. This should eliminate concern that prostate cancer screening will lead to overtreatment of prostate cancer.