• Chart of the day: The USPSTF effect

    I’d bet the blog that most members of the U.S. Preventive Services Task Force aren’t satisfied that over 40% of men 75 years old and above are getting PSA tests. But it should be somewhat gratifying to see that the work of the task force seems to have had a noticeable impact.

    uspstf psa

    The chart is from a new paper by David Howard, et al. in Health Affairs.


    • It’s interesting that there was a change in those over 75, but not in the younger age groups. See this recent publication in JNCI:

      “neither the publication of the two large trials nor the subsequent changes in recommendations had an obvious effect on PSA screening rates for men aged 50 to 64 years, despite extensive media coverage of these events.”

      I wonder why there was a change in those over 75 compared to the younger cohorts. My guess is that it’s related to physician behavior. Many physicians probably agree that those over 75 are unlikely to generate any benefit from PSA screening due to their reduced life expectancy. So physicians may be more assertive about recommending against the PSA for this age group. However, it appears many physicians may still disagree with the PSA clinical trial findings, potentially due to a misunderstanding of cancer screening statistics (http://www.ncbi.nlm.nih.gov/pubmed/22393129).

      • The USPSTF recommendation in 2008 was that men 75 years old and older not receive the PSA test.

        • Yes, but the JNCI article I mentioned has data through 2011.

          I’m not sure the exact timeline for the USPSTF guidelines for middle aged men, but the JNCI mentions:

          “In early 2009, the publication of two large clinical trials reported substantial rates of overdiagnosis of prostate cancer with routine prostate-specific antigen (PSA) screening (1,2). These results led many organizations to change their recommendations on PSA screening (3–5).”
          (they cite ACS and USPSTF publications)

          I know USPSTF has been stronger in their recommendation against screening over the past year, so maybe we’ll see the data change in 2012?