The U.S. Postal Service unveiled a new stamp recently--essentially a stamp of approval. The stamps reads, "Prostate Cancer Awareness: Annual Checkups and Tests." The Postal Service's purpose is to "help spread the word among men young and old about how important it is to discuss this deadly disease with their health care provider."
Because we are concerned that the stamp and the associated fanfare may send the public the wrong message about prostate cancer screening, we believe the stamp should be canceled.
The reason is simple. There is no compelling scientific evidence supporting annual checkups and tests for prostate cancer. While it is known that screening tests such as the prostate specific antigen blood test can identify some prostate cancers when they are very small, no one has demonstrated that screening does what it is meant to do and so often assumed to do: save lives.
Futhermore, there is evidence that widespread screening will identify many men with the disease and will lead some to receive unnecessary treatment. Extrapolating from autopsy data, it is likely that millions of American men age 60 and older harbor silent prostate cancer, but only a small proportion will become sick or die from it.
Unfortunately, once an early-stage tumor is detected by screening, there is no reliable way to know whether it represents a slow-growing or an aggressive form. Although some men elect not to be treated, i.e., they choose "watchful waiting," many undergo radical surgery. And while the benefit of surgery is unproved, its potential harms are well-known: about a 30% chance of incontinence, estimates of a 20% to 85% chance of impotence and occasionally, death. In short, we simply do not know if prostate cancer screening does more good than harm.
This uncertainty is reflected in recommendations of screening experts. The U.S. Preventive Services Task Force (the formal U.S. panel charged with public policy on prevention) and the American College of Physicians recommend against routine screening for prostate cancer. These recommendations are based on the lack of evidence demonstrating benefits, and concerns about the high false alarm rate of prostate cancer screening (15% to 40% of men without cancer will have abnormal PSA tests and require a biopsy to find out that the test result was a false alarm. Even the American Cancer Society, which had given prostate cancer screening an unqualified endorsement, has now changed its recommendation and emphasizes the importance of informing men about the potential harms and benefits so that they may decide for themselves. Given the level of professional uncertainty, the prostate stamp--explicitly designed to "emphasize the importance of annual screening" and to remind men that "early detection is the key to successful treatment"--seems irresponsible.
This stamp of approval raises a larger question: Should the Postal Service avoid health-related stamps altogether? Traditionally, commemorative stamps have focused on historical, artistic or cultural themes rather than health or medical issues. Recently, the Postal Service has issued a number of health-related stamps, arguing that these stamps heighten awareness about important public health issues. But the boundary between public health and advertising on behalf of special interests (e.g. pharmaceutical companies, manufacturers of diagnostic tests, physician specialty societies, specific disease lobbies) can get pretty murky. Should there be a stamp to promote vaccination for Lyme disease? One to encourage MRIs for people with lower back pain? Or one to raise awareness about attention deficit disorder? Any one of these messages would spark debate in the medical community about who the appropriate target audience should be and whether intervention is beneficial.
The public doesn't need the Postal Service to help communicate information about disease. We are already inundated with countless messages about the dangers of disease and the actions we should take. Untargeted messages have the potential to create confusion and an inflated sense of vulnerability.
Perhaps the Postal Service should focus on distributing the mail and avoid distributing controversial health messages that may make people feel sick.