US expert panel recommends against prostate cancer screening

ImportanceIn the United States, the lifetime risk of being diagnosed with prostate cancer is approximately 13%, and the lifetime risk of dying of prostate cancer is 2.5%. The median age of death from prostate cancer is 80 years. Many men with prostate cancer never experience symptoms and, without screening, would never know they have the disease. African American men and men with a family history of prostate cancer have an increased risk of prostate cancer compared with other men.ObjectiveTo update the 2012 US Preventive Services Task Force (USPSTF) recommendation on prostate-specific antigen (PSA)–based screening for prostate cancer.Evidence ReviewThe USPSTF reviewed the evidence on the benefits and harms of PSA-based screening for prostate cancer and subsequent treatment of screen-detected prostate cancer. The USPSTF also commissioned a review of existing decision analysis models and the overdiagnosis rate of PSA-based screening. The reviews also examined the benefits and harms of PSA-based screening in patient subpopulations at higher risk of prostate cancer, including older men, African American men, and men with a family history of prostate cancer.FindingsAdequate evidence from randomized clinical trials shows that PSA-based screening programs in men aged 55 to 69 years may prevent approximately 1.3 deaths from prostate cancer over approximately 13 years per 1000 men screened. Screening programs may also prevent approximately 3 cases of metastatic prostate cancer per 1000 men screened. Potential harms of screening include frequent false-positive results and psychological harms. Harms of prostate cancer treatment include erectile dysfunction, urinary incontinence, and bowel symptoms. About 1 in 5 men who undergo radical prostatectomy develop long-term urinary incontinence, and 2 in 3 men will experience long-term erectile dysfunction. Adequate evidence shows that the harms of screening in men older than 70 years are at least moderate and greater than in younger men because of increased risk of false-positive results, diagnostic harms from biopsies, and harms from treatment. The USPSTF concludes with moderate certainty that the net benefit of PSA-based screening for prostate cancer in men aged 55 to 69 years is small for some men. How each man weighs specific benefits and harms will determine whether the overall net benefit is small. The USPSTF concludes with moderate certainty that the potential benefits of PSA-based screening for prostate cancer in men 70 years and older do not outweigh the expected harms.Conclusions and RecommendationFor men aged 55 to 69 years, the decision to undergo periodic PSA-based screening for prostate cancer should be an individual one and should include discussion of the potential benefits and harms of screening with their clinician. Screening offers a small potential benefit of reducing the chance of death from prostate cancer in some men. However, many men will experience potential harms of screening, including false-positive results that require additional testing and possible prostate biopsy; overdiagnosis and overtreatment; and treatment complications, such as incontinence and erectile dysfunction. In determining whether this service is appropriate in individual cases, patients and clinicians should consider the balance of benefits and harms on the basis of family history, race/ethnicity, comorbid medical conditions, patient values about the benefits and harms of screening and treatment-specific outcomes, and other health needs. Clinicians should not screen men who do not express a preference for screening. (C recommendation) The USPSTF recommends against PSA-based screening for prostate cancer in men 70 years and older. (D recommendation)

Commentary on: Chou R, Croswell JM, Dana T, et al. Screening for prostate cancer: a review of the evidence for the US Preventive Services Task Force. Ann Intern Med 2011;155:762–71.[OpenUrl][1][CrossRef][2][PubMed][3][Web...

ACP Journal Club17 April 2012Review: PSA-based screening does not reduce prostate cancer mortality or all-cause mortalityPhilipp Dahm, MD, MHSc, FACSPhilipp Dahm, MD, MHSc, FACSUniversity of Florida, Gainesville, Florida, USA (P.D.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-156-8-201204170-02002 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Source CitationChou R, Croswell JM, Dana T, et al. Screening for prostate cancer: a review of the evidence for the US Preventive Services Task Force. Ann Intern Med. 2011;155:762-71. https://pubmed.ncbi.nlm.nih.gov/21984740Clinical Impact RatingsGIM/FP/GP: Oncology: References1 US Preventive Services Task Force. Screening for prostate cancer: draft recommendation statement. Oct 2011. www.uspreventiveservicestaskforce.org/uspstf12/prostate/draftrecprostate.htm (accessed 24 Feb 2012). Google Scholar2 NIH Consensus Development Program. NIH state-of-the-science conference: Role of active surveillance in the management of men with localized prostate cancer. Dec 2011. www.consensus.nih.gov/2011/prostate.htm (accessed 24 Feb 2012). Google Scholar Author, Article, and Disclosure InformationAuthors: Philipp Dahm, MD, MHSc, FACSAffiliations: University of Florida, Gainesville, Florida, USA (P.D.)This article was published at Annals.org on 3 April 2012. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 17 April 2012Volume 156, Issue 8Page: JC4-2KeywordsAntigensCancer screeningCancer treatmentMortalityNumber needed to screenProstate cancerResearch designResearch quality assessmentSystematic reviews ePublished: 17 April 2012 Issue Published: 17 April 2012 Copyright & PermissionsCopyright © 2012 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...

Prevalence of preeclampsia risk factors: implications for low-dose aspirin prophylaxis

In 2016, the US Preventive Services Task Force concluded that there was "insufficient" ("I" statement) evidence to support universal primary care screening for autism spectrum disorder. The statement led to controversy among research and clinical communities. Although a number of papers have since been published arguing for the potential benefit of autism spectrum disorder screening, none adequately address the potential harms of autism spectrum disorder screening. This evidence gap may relate to confusion regarding how the US Preventive Services Task Force conceptualizes and evaluates potential harm. In this commentary, we explore how the US Preventive Services Task Force operationalizes harm and discuss how the potential for harm was described in the "I" statement on autism spectrum disorder screening. This information can serve as a guide for investigators working to study the benefits and harms of autism spectrum disorder screening in order to fill the research gaps cited by the US Preventive Services Task Force report. Finally, we recommend future research directions for exploring harms of autism spectrum disorder screening, filling cited research gaps, and ultimately ensuring that the benefits of autism spectrum disorder screening truly outweigh the harms for all children and their families.

In 2008, the US Preventive Services Task Force (USPSTF) updated prostate cancer screening guidelines to recommend against screening for prostate cancer in men aged 75 years or older. We describe the prevalence of prostate-specific antigen (PSA) testing in this population and identify factors that may be correlated with the use of this test. Data came from the 2006 Behavioral Risk Factor Surveillance System. We assessed the status of PSA testing in the past year among 9,033 US men aged 76 or older who had no history of prostate cancer. We conducted descriptive and multiple logistic regression analyses to assess associations of PSA testing with certain sociodemographic and psychosocial factors. Overall, 60% of men aged 76 or older reported having a PSA test in the past year. Men who had health insurance, were satisfied with life, or always had emotional support were significantly more likely to report having a PSA test in the past year. However, men who had no routine health checkup; were divorced, widowed, or separated; or had less than a high school education were significantly less likely to report having had a PSA test. PSA testing is common among men aged 75 or older in the United States. Certain sociodemographic and psychosocial factors were associated with receipt of this test. This study may not only provide baseline data to evaluate acceptance and implementation of the USPSTF screening guidelines but may also help physicians and public health providers better understand these sociodemographic and psychosocial factors in this population.

Colon Cancer Screening Models: Lessons and Challenges

Response to Weinstein’s “Reply of Increased risk of vitamin D deficiency and insufficiency in Black patients with central centrifugal cicatricial alopecia.”

Clinical Preventive Medicine in Primary Care: Background and Practice: 1. Rationale and Current Preventive Practices

Among men worldwide, prostate cancer has become the second most frequently diagnosed cancer and the sixth leading cause of cancer death, accounting for 240,890 new diagnoses and 33,720 deaths in the United States alone in 2011 (1, 2). Fortunately, with wide use of prostate cancer screening, early detection, and definitive local therapy, prostate cancer mortality rates have been falling in the United States—as much as 39% or more since 1990 (2). Nonetheless, randomized clinical trials of serum prostate-specific antigen (PSA) testing for prostate cancer screening have suggested that these gains have come at a significant cost: by one estimate, to save a single life from prostate cancer death, 1,410 men need to be screened, and 48 cases of prostate cancer need to be diagnosed and treated (3). On October 11, 2011, the US Preventive Services Task Force issued a draft report on PSA screening, assigning the practice a grade D recommendation and weighing in “against the service” because of “moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits.” The firestorm of controversy triggered by this report highlights (i) the need for individualized approaches to prostate cancer screening at a population scale, so that screening services can be targeted in such a way as to minimize overdiagnosis, and (ii) the need to personalize treatment decisions, so that options like the use of active surveillance in lieu of definitive local therapy can be rationally selected in such a way as to reduce overtreatment (4, 5). In PNAS, Markert et al. (6) attempt to address these needs through the discovery of new molecular biomarkers for aggressive prostate cancer.

In this issue of Pediatrics , readers will find the recommendation of the US Preventive Services Task Force (USPSTF) that all newborns be screened for hearing loss1; readers will also find a concise version of the systematic evidence report that was commissioned to help develop this recommendation.2 Over the last several years, Pediatrics has published 5 recommendations relevant to children from the USPSTF3–7 and plans to publish additional recommendations as they are released. Because many pediatricians know very little about the USPSTF,8 we would like to use this commentary to inform readers about this task force: what it is, who is involved, how it works, and what readers can expect from these publications. The USPSTF is an independent panel charged by the US Congress to review the scientific evidence for clinical preventive services and develop evidence-based recommendations for the health care community. It was first convened by the US Public Health Service in 1984 and, since 1998, has been sponsored by the Agency for Healthcare Research and Quality (AHRQ). The USPSTF comprises 16 private-sector experts in prevention and primary care, representing primary care specialties and nursing, who serve for terms of 4 to 6 years. Members of the USPSTF are nominated by federal agencies, partner organizations (such as the American Academy of Pediatrics [AAP]), and individuals in response to an announcement in the Federal Register . Members are chosen for their ability to make rigorous, impartial assessments of the scientific evidence for the effectiveness of a broad range of clinical preventive services, including screening, counseling, and preventive medications, and synthesize these assessments into recommendations. Throughout its existence, the task force has had at least 2 pediatricians, as well as other pediatric health care providers, among its members. Currently, 3 of its 16 … Address correspondence to Virginia A. Moyer, MD, MPH, Baylor College of Medicine, Department of Pediatrics, 6621 Fannin St, #1540, Houston, TX 77030. E-mail: moyer{at}bcm.edu

The US Preventive Services Task Force (USPSTF) has issued a draft recommendation statement on screening for prostate cancer, based on an updated systematic evidence review and assessment of the evidence. The full draft recommendation is available for public comment on the USPSTF website1 through May 8, 2017. The USPSTF has proposed the following draft summary language and grade:

The prevalence of childhood and adolescent overweight has tripled over the past 2 decades, and associations have been identified between dietary patterns, physical activity, sedentary behaviors, and overweight. Some believe that pediatricians can easily recognize an overweight or obese child or adolescent and that there are sufficient therapeutic options to offer these patients and their families.1 However, primary care clinicians face obese and overweight children, adolescents, and parents every day, and most clinicians rarely document overweight. The American Academy of Pediatrics and American Academy of Family Physicians endorse universal screening using body mass index (BMI) and use of BMI growth curves to identify obese and overweight children. Physicians also seem to take high BMI more seriously than weight and height measures2; when documentation of high BMI occurs, screening, counseling, and referral rates for obese and overweight children and adolescents increase.3 Why then, does the US Preventive Services Task Force (USPSTF), in this issue of Pediatrics ,4 find insufficient evidence to recommend for or against formally screening children and adolescents for obesity or overweight in the primary care setting? The answer is: the USPSTF adheres strongly to a policy of making recommendations (either for or against delivery of preventive services) only in the presence of sufficient evidence of adequate quality. The USPSTF cannot make a recommendation for or against screening even for a practice that may be supported by expert consensus or less rigorous evidence. It is important to note that the USPSTF did not recommend that primary care clinicians not weigh and measure children or ignore … Address correspondence to Program Director, USPSTF, Agency for Healthcare Research and Quality, 540 Gaither Rd, Rockville, MD 20850. E-mail: uspstf{at}ahrq.gov

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Doing It Right: How, Not Whether, To Perform Prostate-specific Antigen Screening