Press release

Should physicians screen for prostate cancer?

p. 1368  Screening for prostate cancer: estimating the magnitude of overdetection — Maurice McGregor, MD; James A. Hanley, PhD; Jean-François Boivin, MD, DSc; Richard George McLean, MB, BS [abstract / résumé]

p. 1375  Prostate cancer screening: waiting for Godot — Neill A. Iscoe, MD [full text]

Is screening for prostate cancer justifiable? Recent evaluations indicate that it might help men under age 70; others have concluded there is insufficient benefit. Unfortunately there have been no randomized controlled trials of screenings. Dr. Maurice McGregor and colleagues have instead estimated benefits and risks based on the prostate cancer mortality rate in Quebec and the results of 2 recent screening studies.

The authors estimate that of every 100 men whose cancer is detected by screening, 16 may have their lives extended by surgery; the remaining 84 would not die of their cancer before age 85. The problem is that the treatment itself — radical prostectomy — is potentially harmful and carries considerable risks. And even among the 16% who might benefit, the condition of an estimated one-quarter of them would be too far advanced for surgery.

Dr. Neill Iscoe highlights some of the important assumptions underlying such estimates of the magnitude of overdetection and argues that a randomized clinical trial is desperately needed. He notes that even when the results of such a trial become available, the most difficult questions surrounding screening for prostate cancer and other diseases will remain to be answered: What level of overdetection is acceptable, and how much benefit to how many people makes screening worth while?

p. 1359  Participation in clinical trials among women living with HIV in Canada — Catherine Hankins, MD, MSc; Normand Lapointe, MD; Sharon Walmsley, MD; and the Canadian Women's HIV Study Group [abstract / résumé]

p. 1373  The evolution of clinical trials: inclusion and representation — Paula A. Rochon, MC, MPH; Philip B. Berger, MD; Michael Gordon MD [full text]

Even though it is important for clinical trial participants to be representative of the population for which the drug or therapy is intended, certain groups continue to be "underdetected" by sampling methods. Catherine Hankins and colleagues found that about one-quarter of the 413 HIV-positive women in the Canadian Women's HIV Study have participated in AIDS drug trials. Although this overall participation rate is high, injection drug users, nonwhite women, women who did not complete high school and women not receiving antiretroviral therapy are underrepresented. The authors recommend that the HIV clinical trials recruit women with these characteristics.

Reminding us that fit, young men are not the only people who become ill and receive therapy, Paula Rochon and associates urge researchers to recruit participants from marginalized groups into clinical trials in order to help ensure that study results are generalized and to improve health outcomes in all segments of the population. They point to the underrepresentation of elderly subjects in trials for new drugs and therapies. In major drug trials evaluating nonsteroidal anti-inflammatory drugs, only 2.1% of patients were 65 years of age or over, yet elderly people are among the largest users of the drugs and have the highest incidence of serious drug-related side effects.

p. 1389  The early years of radiation protection: a tribute to Madame Curie — Arty R. Coppes-Zantinga, MA; Max J. Coppes, MD, PhD [full text]

Marking the 100th anniversary of the discovery of radium with a tribute to research pioneer Marie Curie, authors Arty Coppes-Zantinga and Dr. Max Coppes describe the fingers burned, marrows destroyed and lives lost in the quest to study and improve radiology, radiation therapy, x-rays and radiation-protection measures.

Although Marie and Pierre Curie initially chose to ignore exposure to radioactivity as a health hazard, they later recognized the dangers it posed in untrained hands and advocated training. Up until 1995, it was assumed that Marie Curie died in 1934 because of radium exposure. But in 1995 when her body was exhumed for reburial in France's national mausoleum, it was discovered that she most likely died as a direct result of overexposure to x-rays during World War I, when she established mobile radiographic units.