New medical innovations become accepted by the medical community and public through various routes and with different levels of evidence.
When prostate-specific antigen (PSA) testing for prostate cancer screening first became available in about 1986, its use skyrocketed. Although studies were done, the benefits of PSA testing as a routine screening test were uncertain. In fact, whether to routinely perform PSA testing for the early detection of prostate cancer has remained controversial for nearly 25 years. Even the recent publication of two large randomized trials hasn’t fully resolved this important issue.
In contrast, the technology for CT colonography (also called virtual colonoscopy), a radiologic means of conducting a screening colonoscopy in place of an optical colonoscopy, has been a slow and gradual developmental process. A major goal of both screening tests is to identify premalignant colorectal adenomas that can then be removed. Little by little, each new study has incrementally added more new information about the efficacy of this potential screening modality. Today CT colonography is an alternative option for colorectal screening. Although the routine use of CT colonography remains controversial (see the Pro-Con debate in this issue of our Newsletter), there certainly appears to be a role for this test in some clinical settings.
Both PSA screening and CT colonography are going to be part of the cancer screening and prevention landscape for a long time to come. What is crucial for all such tests is the background slow and incremental process of data acquisition, to build the evidence on which both the medical community and lay public can rely as they make their own day-to-day judgments on how and when to use such tests.
The Editors
Andrew J. Dannenberg, M.D.
Henry R. Erle, MD-Roberts Family Professor of Medicine
Cancer Center Director
Weill Cornell Medical College
Co-Director, Cancer Prevention Program
New York-Presbyterian Cancer Centers
Alfred I. Neugut, M.D., Ph.D.
Myron M. Studner Professor of Cancer Research
Professor of Medicine and Epidemiology
Associate Director for Population Sciences
Herbert Irving Comprehensive Cancer Center
Columbia University College of Physicians and Surgeons
and Mailman School of Public Health
Co-Director, Cancer Prevention Program
NewYork-Presbyterian Cancer Centers
