While Americans appear to disagree an increasing number of, cancer screening is an exception. Who wouldn't help prevent or discover cancer at an earlier, more treatable stage, when the choice is pain, toxic treatments, and short lives? This is why people get confused when news headlines don't reinforce the “just do it” message. A recent example of the disconnect between public perception and clinical evidence is prostate cancer screening using the prostate-specific antigen (PSA) test. The United States Preventive Services Task Force (USPSTF), a nongovernmental expert panel that develops guidelines for primary care providers, Presented new recommendations. That said, doctors should order the PSA test for older men only after discussing its pros and cons and clarifying preferences for screening.
Screening for prostate cancer with the PSA test: the backstory.
A temporary history of this test is required to grasp the brand new draft suggestion. Introduced within the Nineteen Eighties as a method to follow patients already diagnosed with prostate cancer, it has since been used to screen for brand spanking new cancers. Given that the PSA was a straightforward blood test to perform, it was quickly adopted – without waiting to see if it actually worked. For a few years, the USPSTF said there There was not enough information Recommending for or against a PSA test.
That modified in 2012 when the USPSTF issued a Controversial recommendation against screening. This was based on a big US study that showed no reduction in prostate cancer mortality amongst men screened with the PSA test. The proposal also reflects concerns concerning the test resulting in a rise in prostate cancer diagnoses, lots of which were small, low-risk cancers that were being treated with surgery or radiation — common uncomfortable side effects. Treatment with effects.
I used to be uncomfortable with this “don't screen” suggestion and am blissful with the proposed change. Here's why: While the US screening trial was negative, one other large study in European men found a modest reduction in prostate cancer deaths after greater than 10 years of follow-up. What's more, experts have devised latest strategies to avoid treating low-risk cancers.
Discussing screening with the PSA test
I discuss the professionals and cons of the PSA test with my patients and ask about their personal preferences for screening. I tell them that screening can reduce prostate cancer deaths by 20%, however the “bang for the buck” is small. More than 1,000 men must be screened to stop one death. I also highlight that the good thing about screening lasts for years, however the risks of treatment—impotence, incontinence, and bowel problems—occur immediately.
I also emphasize that the PSA test will not be very accurate. False-positive results may cause anxiety, meaning further testing shows no cancer. I mention the potential of diagnosing low-risk cancers where treatment may make the disease worse, and closely following them without treatment could also be preferable. How much a person desires to know something like this could vary—some see it as useful information, others see it as an infinite source of tension.
Finally, I share my viewpoint. While learning concerning the PSA test as a medical student within the late Nineteen Eighties, my grandfather was dying of prostate cancer. He was a healthy man with many good years left, and I wondered if the PSA test could have helped him. Because of this family history, I made a decision to have a PSA test. But I'm not even sure what I might do if I didn't have that history. The small potential for profit should be weighed against the danger of false positives or finding low-risk tumors that might never cause harm. I can see how two men without prostate cancer risk aspects might make different decisions.
So, I believe the USPSTF got it right. This is a wonderful decision that an informed patient makes along with their doctor. The challenge in implementing that is practical: I actually have less time with each patient. I can save time by just ordering the test with none discussion. But in my role as a health consultant, I would like to find a way to say not only when I believe we must always or shouldn't do something, but when there’s a alternative. And while there isn't one right decision for everybody, my patient is the perfect person to make the fitting alternative for her. I can state my personal preference, but need to focus on why this will not be the right answer for this.
Sources
US Preventive Services Task Force 2017 Draft Recommendation Statement on Prostate Cancer Screening: An Invitation for Review and Comment. JamaPublished online April 11, 2017.
Screening for prostate cancer: recommendation statement of the US Preventive Services Task Force. History of Internal MedicineAugust 2008.
Understanding Task Force Recommendations, Prostate Cancer Screening. US Preventive Services Task Force, May 2012.