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Action Points
- A small but significant number of older Medicare beneficiaries had a decline in prostate-specific antigen (PSA)-based cancer screening after the USPSTF recommended against the screening study in 2008.
- Point out that rates of PSA screening for men ages 75 and older were around 30%, which suggested that relatively few clinicians changed their practice.
A small but significant number of older Medicare beneficiaries saw a decline in prostate-specific antigen (PSA)-based cancer screening after the U.S. Preventive Services Task Force (USPSTF) recommended against the screening in 2008, researchers said.
The adjusted screening rate for that age group declined by 2 percentage points over a 15-month period after the recommendation, from 29.4% in the prior year down to 27.8%, reported Joseph Ross, MD, MHS, of Yale University, and colleagues in an online research letter in the Archives of Internal Medicine.
Still, rates of PSA prostate screening for men ages 75 and 0lder were around 30%, which suggested that relatively few clinicians changed their practice accordingly, they said.
These findings may give a clue about what to expect with the USPSTF's recent definitive stand against any PSA screening for healthy men.
"While the impact of this recommendation will not be immediately understood in practice, the impact of the USPSTF's August 2008 recommendation to discontinue PSA-based prostate cancer screening for men 75 years and older may inform expectations," the group explained.
Although the drop in screening rates was statistically significant, it wasn't enough, they argued. "For a screening test where the harms have been shown to outweigh the benefits, rates of PSA-based prostate cancer screening still neared 30%, suggesting that greater efforts are needed to change practice," the group wrote.
They acknowledged that recommendations to discontinue care are challenging, but the rationale for the USPSTF's opinion against PSA cancer screening cited a benefit of no more than one prostate cancer death avoided per 1,000 men screened versus a high rate of false-positives, with their accompanying psychological harm and complications.
Ross's group examined the Surveillance, Epidemiology, and End Results (SEER) database cross-matched with Medicare records along with a 5% sample of Medicare beneficiaries without cancer residing in SEER program areas.
The pre-recommendation period that they looked at was 15 months from April 2007 and the post-recommendation period was June 2008 to October 2008. This allowed for what they called a "washout" period for dissemination of the August 2008 USPSTF guideline.
According to the results of this quasi-experimental study, elderly men were screened somewhat less often than younger men across the periods studied, with a gap for dissemination. Rates for men ages 66 to 74 and 75 and older, respectively, were:
- 33.9% versus 29.4% during the pre-recommendation period from April 2007 through June 2008
- 34.4% versus 27.8% during the post-recommendation period from October 2008 through December 2009
That slight downward shift in rate between periods for the elderly men amounted to an absolute difference of 2 percentage points after adjustment for race and clinical comorbidities (P<0.001).
The effect of the recommendations didn't appear to vary by the regional PSA screening rate beforehand or by urologist density.
The study was supported by the P30 Cancer Center Support Grant at the Yale Comprehensive Cancer Center.
Ross reported support by a National Institute on Aging grant and by the American Federation for Aging Research through the Paul B. Beeson Career Development Award Program, from the Centers of Medicare and Medicaid Services, to develop and maintain performance measures that are used for public reporting, and from the Pew Charitable Trusts to examine regulatory issues at the FDA.
Primary source: Archives of Internal Medicine
Source reference:
"Impact of the 2008 US Preventive Services Task Force Recommendation to discontinue prostate cancer screening among male medicare beneficiaries" Arch Intern Med 2012; DOI: 10.1001 /archinternmed.2012.3726.
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