This month in the Journal of Clinical Oncology a report from the Prostate, Lung, Colorectal, and Ovarian Cancer screening trial (PLCO) highlights priorities for cancer prevention 1. In a detailed analysis that addresses the potential for PSA screening to reduce mortality from prostate cancer in this randomized trial, the authors report that more than 9,500 men who were participating in the PLCO prevention trial died during 10 years of follow-up. Only 164 of these 9565 men died from prostate cancer (1.7% of deaths). The men were ages 55 to 74 at enrolment into the study and came from 10 study centers across the United States. Given so few deaths were due to prostate cancer among these men who were otherwise healthy at entry to the study, it is clear that other chronic diseases far outweighed or dominated prostate cancer as a cause of premature death among men (defined as death before age 85, the approximate mid point age for all deaths in the US with half occurring in those younger than 85 and half in those older than 85).
Why do we focus so “religiously” on seeking new causes of specific cancers, early detection methods, and strategies to reduce mortality from such relatively rare causes of premature mortality, when at the same time the population becomes more obese, and men are dying from many preventable causes other than prostate cancer?
As Mokdad 2 notes the leading preventable causes of death in the United States in 2000 were tobacco (18.1% of total US deaths), poor diet and physical inactivity (15.2%), and alcohol consumption (3.5%). These common causes of death can be changed – as we have noted previously. Risk is reduced after cessation from smoking and after weight loss or increase in physical activity. Unnecessary premature deaths can be avoided. See the Your Disease Risk site for personalized tips to lower your risk of disease.
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1. Crawford ED, Grubb R, 3rd, Black A, et al. Comorbidity and mortality results from a randomized prostate cancer screening trial. J Clin Oncol. Feb 1 2011;29(4):355-361.
2. Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the United States, 2000. JAMA. Mar 10 2004;291(10):1238-1245.