Cancer society stops urging docs to offer PSA test

New advice from the American Cancer Society puts a sharper focus on the risks of prostate cancer screening, emphasizing that annual testing can lead to unnecessary biopsies and treatments that do more harm than good.

The cancer society has not recommended routine screening for most men since the mid-1990s, and that is not changing. But its new advice goes farther to warn of the limitations of the PSA blood test that millions of American men get now. It also says digital rectal exams should be an option rather than part of a standard screening.

The new advice is the latest pushback from routine screening to hunt for early cancers. Last year, a government task force said most women don’t need mammograms in their 40s and a doctors group said most women in their 20s don’t need annual Pap tests.

American men have long been urged to have prostate cancer screenings, but over time studies have suggested that most cancers found are so slow-growing that most men could have avoided treatment.

The Atlanta-based cancer society is perhaps the most influential group in giving screening advice. Its new guidance released Wednesday on prostate cancer urges doctors to:

_Discuss the pros and cons of testing with their patients, including giving them written information or videos that discuss the likelihood of false test results and the side effects of treatment.

_Stop giving the rectal exam as a standard prostate cancer screening because it has not clearly shown a benefit, though it can remain an option.

_Use past PSA readings to determine how often followup tests are needed and to guide conversations about treatment.

Prostate cancer is the most common non-skin cancer in American men. An estimated 192,000 new cases and 27,000 deaths from it occurred last year in the United States.

But it is a slow-growing cancer in many cases, and depending on a man’s age, he may be more likely to die of something else. Major studies have suggested routine screening doesn’t save lives and often leads to worry and unnecessary treatment.

The new cancer society recommendations could be “game changers” in two respects, said Dr. John Davis, a urologist who directs prostate cancer screening programs for the University of Texas M.D. Anderson Cancer Center in Houston.

First, they could change how routine physical exams for many older men are conducted, he said. About 41 percent of men 50 and older get annual prostate cancer screenings. Even though the cancer society doesn’t recommend routine PSA tests, many doctors do it without even asking their patients. And there’s little conversation about it unless the test gives a worrisome result. The new guidelines may spur doctors to talk to their patients earlier about the pros and cons of getting the test in the first place.

Second, the guidelines could have a chilling effect on community prostate screening clinics in which hundreds of men line up and get free, quick exams, Davis said.

That was the intent, said Dr. Andrew Wolf, a University of Virginia physician who led the group that write the new guidelines.

“Yes, the guideline was explicitly crafted to put a damper on those community prostate screening activities that do not offer men the opportunity to make an informed decision whether to screen,” Wolf said.

Prostate cancer screening became a medical mantra in the 1990s, thanks to the development of the PSA test. Some celebrities became advocates for routine testing, including former New York City Mayor Rudy Giuliani and the actor Brad Garrett from the TV sitcom “Everybody Loves Raymond.” In 2008, Garrett underwent an on-the-air digital rectal exam for a TV special called “Stand Up To Cancer.”

But concerns about the value of routine screening increased last year, after two large studies concluded screening for prostate cancer doesn’t necessarily save lives, and noted any benefits can come at a high price.

The American Urological Association — a longtime proponent of regular screening — last year backed off its call for annual tests after age 50. The group said men should be offered a baseline PSA test at age 40, with follow-ups at intervals based on each man’s situation.

The group also has stood by the rectal exam as a standard part of screening, saying it can find cancer that the blood test does not.

The cancer society has been more cautious about regular screenings for some time. The organization last issued guidelines in 2001, which said merely that doctors should offer screening and discuss the risks and benefits.

The new guidelines back away even more, dropping the sentence that doctors should offer prostate screening. Instead, the society says some evidence indicates periodic screening can save lives but that there are significant uncertainties about the overall value of finding prostate cancer early. Screening should not take place, the new advice says, unless a patient is fully informed of the trade-offs.

In a nod to the busy workload of doctors, the guidelines recommend videos, brochures and other “patient decision aids.”

Men at average risk should get detailed information around age 50, the society recommends. Men at higher risk, including African-Americans and men with a father or brother who had prostate cancer before age 65, should get the information beginning at age 45. Men with more than one close relative with prostate cancer before 65 should get such information at age 40.

For men who want to be screened regularly, the new guidelines recommend every other year if the PSA reading is less than 2.5, a measure of prostate specific antigen per milligram of blood. Annual tests are recommended for 2.5 or higher and a 4 suggests consideration of a biopsy.

The urological association considers the cancer society’s advice too simplistic and says it’s important to consider any rapid rise in PSA results.

The society’s new guidelines rankled Skip Lockwood, president and CEO of Zero — The Project to End Prostate Cancer, formerly known as the National Prostate Cancer Coalition.

Lockwood’s group recommends annual PSA tests for men beginning at 45, and conducts mobile prostate cancer screening programs at state fairs, churches and other sites. The group provides information about the risks and benefits of screening, and connects men to follow-up care if needed, he said.

What bothers him most in the new guidance is “the certainty of its tone,” Lockwood said.

“We acknowledge that the PSA test is lacking. I think nobody disagrees on that fact. I think that we all understand that this is not cut and dry — not an all or nothing situation,” he said.

Russian Olympic chief resigns after Vancouver flop

The head of the Russian Olympic Committee resigned Wednesday in the wake of the traditional powerhouse’s worst performance at the Winter Games, news agencies reported.

Leonid Tyagachev, a former sports minister who’d led the committee since 2001, stepped down two days after President Dmitry Medvedev warned that sports officials would be fired if they failed to resign voluntarily.

“Leonid Tyagachev has offered his resignation,” committee spokesman Gennady Shvets said, according to the Interfax news agency. “This obviously concerns the Russian athletes’ performance at the Vancouver Olympic Games.”

Russia won just 15 medals — only three golds — two fewer than its previous low in Salt Lake City in 2002.

Officials said before the Vancouver Games that 30 medals and a top-three finish in the medal standings were the targets. Russia placed 11th for golds and sixth in the overall medal count, results that proved particularly embarrassing as the country takes the torch for the next Winter Olympics in its Black Sea resort of Sochi in 2014.

The 63-year-old Tyagachev helped Russia win hosting rights to the Sochi Games. He is a personal friend and, according to some Russian news reports, a former ski instructor of Prime Minister Vladimir Putin.

There was no word on a replacement.

Sports Minister Vitaly Mutko said Tuesday in televised comments that he would “calmly leave” his post if Medvedev’s warnings were directed at him. Mutko — who has so far resisted calls to resign from a wide array of Russian politicians — on Monday blamed several factors for the Vancouver flop.

He said the team was unlucky, that no one in Russia takes new winter sports such as freestyle skiing seriously and doping bans had deprived Russia of several leading medal contenders.

In Memoriam is touching to watch, painful to make

The Kodak Theatre goes quiet as the big screen at center stage begins flashing images of actors and filmmakers who have died. A photo of Heath Ledger or Paul Newman might move the audience to spontaneous applause. Other images inspire deep sighs, as viewers reflect on the entertainers who have touched our lives.

The In Memoriam segment can be the most moving part of the Oscar telecast. It’s also the toughest to produce.

“It is the single most troubling element of the Oscar show every year,” says Bruce Davis, executive director of the Academy of Motion Picture Arts and Sciences. “Because more people die each year than can possibly be included in that segment.”

Davis’ office keeps a running list of academy members and others in the movie business who have passed since the previous year’s segment was compiled. Then, a few weeks before the awards, he and a small committee of academy officials whittle the list of more than 100 names down to the 30 or so folks who will be included in the show’s memorial — from the famous faces viewers at home are sure to recognize to the behind-the-scenes workers familiar only to academy members.

“It gets close to agonizing by the end,” Davis says of the annual meeting. “You are dropping people who the public knows. It’s just not comfortable.”

Oscar’s In Memoriam montage began in the early 1990s and other awards shows followed suit, including the Screen Actors Guild Awards, Grammys and Emmys — all of which go through the same painful process every year.

“It’s a killer because we have hundreds of members that pass each year and we can’t get them all in,” says SAG Awards producer Kathy Connell.

The film academy gives its final list of in-memoriam honorees to the producer of the segment just days before the big show. Chuck Workman, who is producing the memorial montage for Sunday’s telecast, says he was working with a temporary list until last week.

Many of the names made the final cut, he says, but some did not.

“It’s a constant balance for the academy,” says Workman, who has 20 years of experience making film montages for the Oscar show. “They do try their best, but there’s only so many spots.”

Workman says his first step would normally be to choose “some schmaltzy music” to accompany the segment, but this year the music “is coming directly from something they’re doing for the show.”

Workman’s task, then, is to find footage and photographs that best represent the 30 or so people in the memorial piece. He looks for images that “they would be proud of, their families would be proud of and the people in the audience would be proud of.”

For Patrick Swayze, who died Sept. 14, Workman picked clips from “Dirty Dancing” and “Ghost.”

But Workman notes that “In ‘Ghost,’ you don’t want it to look too much like he died.”

Using computers and digital editing software, he assembles the sequence like a puzzle.

“It’s very tricky,” he says. “You want a good juxtaposition, but you don’t want it to be too cute. It’s really an honor to the people who died.”

Davis, meanwhile, is already prepared for the calls he always gets after the show from family members upset that their loved one wasn’t included in the memorial piece.

“They’re brokenhearted sometimes,” Davis says. “There’s nothing you can say that will make them feel better.

“I always hope that they take some comfort that the very fact that they worked in movies confers a certain amount of immortality … and their work lasts longer than being briefly acknowledged in a short clip sequence at one show in one year.”

Still, he takes the calls personally and feels the callers’ pain.

Davis says he’s “never had an enjoyable year” working on Oscar’s memorial segment. But it’s always worth it to pay tribute to those who have died.

“Even though I’ve been keeping the list as we went along, it’s always stirring to see it all assembled and just remember how much extraordinary work a list of 25 to 30 people may represent,” he says. “It’s important because even though every given Academy Awards broadcast is about the year just past, this is a way of evoking the whole history of movies.”

With the Oscars days away, Hollywood gets busy

If the Academy Awards are like the Super Bowl of entertainment, then it’s game week in Tinseltown.

There are cocktail parties in every corner of the city. Gift lounges have sprouted up like spring flowers. Calendars are crammed with dress fittings and shoe fittings and diamond fittings, not to mention countless lunches and dinners in honor of various nominees. Meanwhile, rehearsals are going on inside the Kodak Theatre.

All of Hollywood is gearing up for Sunday’s big game — the Oscars. Here’s the latest:

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DRINKS WITH HISTORY: The week just started and the Oscar parties have already begun. Entertainment site TheWrap.com held its Oscar soiree Monday night at the Four Seasons, and Los Angeles Times’ awards section The Envelope celebrated the season Tuesday with a cocktail party at the Hollywood Museum.

Costumes from Oscar-nominated films filled the exhibition cases inside the historic Max Factor building. There were the military uniforms from “The Hurt Locker,” Sandra Bullock’s dress from “The Blind Side” and the romulan pistol from “Star Trek.” Also on display: Meryl Streep’s costumes from “Julie & Julia” and Brad Pitt’s Nazi-killing garb from “Inglourious Basterds.”

The museum also holds such relics as Judy Garland’s ruby slippers from “The Wizard of Oz” and the first Irving Thalberg award, presented at the 1937 Oscar ceremony.

Guests from the media, the actors union and nearby studios toasted Hollywood history as they geared up for the latest chapter at Sunday’s 82nd Academy Awards.

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HOLLYWOOD HALTED: Hollywood Boulevard — and its merchants — are martyrs for the Academy Awards.

The famous street shuts down for several blocks each year to accommodate Oscar’s red carpet, fan bleachers and stages outside the Kodak Theatre.

Hollywood Boulevard is closed between Highland Avenue and Orange Drive until March 9. The subway stop at the Hollywood & Highland complex will also be closed beginning Saturday.

Fifth of adults choose pet over partner on Valentine’s Day

Rather than spending Valentine’s Day with their partner, one-fifth of adults would prefer to be with their pet, although the French still came top for romance, according to a joint global poll by Reuters/Ipsos.

The survey of 24,000 people in 23 countries found 21 percent of adults would rather spend February 14 with their pet than their spouse, although the French were least likely to choose a furry friend over a human with only 10 percent taking that option.

But the survey found that age and income were more of a determining factor than nationality when it came to romance, with younger, less affluent people more likely to choose their pet as their Valentine’s Day companion.

John Wright, senior vice president of Ipsos, said 25 percent of people aged under 35 opted for their pet over their partner compared to 18 percent of those aged 35-54 and 14 percent of people aged 55 plus.

Men and women were evenly split over the question.

Those choosing pets over people were also more likely to be those who have a lower income (24 percent) compared to those who were middle or higher income earners (20 percent).

“Likely defying stereotype, the desire to spurn a partner for a pet is not rooted in gender but rather age and even there it seems the older you are, the least likely it is you’d choose pet over partner,” said Wright.

“While there are country differences, it’s more of a personal choice made by younger and less affluent individuals.”

On a country-by-country basis, residents of Turkey were the most likely, at 49 percent, to choose their pet over their spouse or partner.

Next came India with 41 percent, then Japan with 30 percent, China with 29 percent, the United States with 27 percent and Australia with 25 percent.

On the other hand, the nations where residents were the least likely to want to spend the day with a pet instead of their spouse or partner were France at 10 percent, Mexico 11 percent, the Netherlands 12 percent and Hungary at 12 percent.

About 1,000 individuals participated on a country by country basis via an Ipsos (http://www.ipsos.com) online panel with weighting employed to balance demographics and ensure that the sample’s composition reflected that of the adult population according to the most recent country census data.

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