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Wednesday, October 31, 2007

"I had prostate cancer, five, six years ago. My chances of surviving prostate cancer -- and thank God I was cured of it -- in the United States: 82 percent. My chances of surviving prostate cancer in England, only 44 percent under socialized medicine."

-- Rudy Giuliani, New Hampshire radio advertisement, Oct. 29, 2007

The former New York mayor has had experience battling prostate cancer, but he's confused about the stats, according to several experts we consulted.


As factual support for the presidential candidate's claim, his campaign cited an article by David Gratzer that appeared in the City Journal, published by the Manhattan Institute, a conservative New York think tank, slamming the Canadian and British systems of "socialized" medicine. The article provides no sources for its assertions about five-year survivability rates for prostate cancer.

Experts from the National Cancer Institute and the urology departments at Johns Hopkins University and the University of Kansas agreed that Giuliani's figures were way out of date, if they were ever accurate at all. The latest official figures for five-year "survivability" rates for prostate cancer are about 98 percent in the United States and 74 percent in England.

More important, the survivability figures tell us little about the differences in the quality of treatment received by prostate cancer patients in the United States and Britain. Doctors in each country have different philosophies about how to treat the disease, and these differences have greatly influenced the survivability statistics.

In the United States, there has been a big emphasis since the 1990s on early screening through prostate-specific antigen (PSA) testing. Five-year survivability rates have increased simply because the slow-developing disease is being diagnosed at a preliminary stage. If the diagnosis is made early, the chance of surviving for five years is close to 100 percent. Britain is several years behind the United States in the widespread use of PSA testing.

Another way of comparing treatment of prostate cancer in the United States and Britain is to look at the mortality rates. Here the two are much closer. About 25 men out of 100,000 are dying from prostate cancer every year in both countries. The likelihood of dying from prostate cancer is roughly comparable in the two countries, despite different treatment philosophies.

J. Brantley Thrasher, chairman of the Department of Urology at the University of Kansas, said it is "impossible to say" on the basis of the statistics whether a prostate cancer patient has a better chance of surviving under a "capitalistic" or "socialistic" medical system. American doctors tend to be more "interventionist" and more likely to advocate surgery than their counterparts in Britain or Canada, where greater emphasis is put on "active surveillance." In the United States, a patient with a good health-care plan is "more empowered to make decisions" for himself.

Maria Comella, deputy communications manager for the Giuliani campaign, sent us the following e-mail explaining the mayor's mistake without quite acknowledging it:

"Mayor Giuliani is an avid reader of City Journal and found the passage in the Gratzer article himself. He cited the statistics at a campaign stop, and the campaign used a recording from that appearance in the radio ad. The citation is an article in a highly respected intellectual journal written by an expert at a highly respected think tank which the mayor read because he is an intellectually engaged human being."


Giuliani is simply wrong when he claims that his chances of surviving prostate cancer are almost twice as high in the United States as in England, under a "socialized" medical system. We award Giuliani four Pinocchios.

To find out the winner of the Fact Checker's first Geppetto award, and coverage of Tuesday night's Democratic debate, visit http://.

© 2007 The Washington Post Company

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