As a boy, Ophni Davis dreamed of becoming a doctor. Instead, he became a barber. But he still considers it his job to look after people's welfare.
So if a man who looks about the right age comes into his Blue Hills Avenue salon in Hartford, Connecticut, Davis will make a pitch for him to get screened for prostate cancer.
He knows what they're thinking: the dreaded digital rectal examination, which, along with a blood test, constitutes a prostate cancer screening.
"No, no, no, man, it's not that kind," he tells them. Then he lets them know: You can get screened with just a blood test.
"It does make a big difference in getting people to do it," Davis said.
Digital rectal exams have been around for more than a century as a way to detect prostate cancer. These days, doctors also use them as part of screening for colorectal cancer and to detect infections or other conditions. They come with little risk or cost.
But increasingly, some doctors are questioning whether the benefits they offer in detecting prostate cancer are enough to outweigh the number of men they scare off.
That view gained support earlier this month when the American Cancer Society released new guidelines for prostate cancer screenings and advised that the prostate-specific antigen, or PSA, blood test could be done with or without the rectal examination. The cancer society cited concerns that the rectal exam may discourage men from getting screened and uncertainty about the value such exams add to cancer screening, although it did identify circumstances when the exam might be useful.
Not everyone believes ditching the rectal exam is a good idea. But the cancer society's recommendation affirmed what Dr. Andrew Salner, director of the Helen & Harry Gray Cancer Center at Hartford Hospital, has been seeing.
In the past, doctors involved in the community outreach programs the hospital runs believed that a complete screening required both the blood test and the digital rectal exam. Through the outreach program, perhaps 100 men a year got screened.
More recently, doctors in the program have come to view the rectal exam as much less important than the blood test. They made the rectal exam optional, under the idea that it was better to get more people in high-risk groups screened than to worry about a test that adds limited value, Salner said.
The year after the change, more than 700 men got tested.
The Screening Debate
The cancer society's guideline on the rectal exam was part of a larger set of recommendations for prostate cancer screening, released amid a debate about the value of screening.
The logic behind screening is fairly straightforward: By testing patients before they have symptoms, you can potentially find cancer in its early stages, treat it, and keep the patient from dying of cancer.
But when it comes to prostate cancer, experts disagree about the extent to which that happens.
There is little doubt PSA testing catches more cases. Since the test became widespread in the U.S. in the 1990s, the incidence of prostate cancer rose dramatically.
But while deaths from prostate cancer have fallen in that time, it has not come at a degree that matches the rise in cases.