Tuesday, April 11, 2017

The USPSTF is at it Again!

The USPSTF has been at it again and again especially in suggesting that prostate cancer screening be denied.

First let us examine just who these folks are:

Task Force members come from the fields of preventive medicine and primary care, including internal medicine, family medicine, pediatrics, behavioral health, obstetrics and gynecology, and nursing. Their recommendations are based on a rigorous review of existing peer-reviewed evidence and are intended to help primary care clinicians and patients decide together whether a preventive service is right for a patient's needs.

Namely they generally are NOT specialists in the area upon which they are opining. Frequently they are administrators or academics.

Second, they have now modified their PSA recommendation from a D to a C. D means useless and C means a toss up. As Healio notes:

5 years after the U.S. Preventive Services Task Force issued a recommendation against PSA screening for prostate cancer in all men — the task force amended its stance in a draft statement, determining that the decision about whether to be screened should be an individual one.
The new recommendation — which changed the grade for PSA screening from D to C — states the potential benefits and harms of PSA–based screening are closely balanced in men aged 55 to 69 years. As a result, the U.S. Preventive Services Task Force (USPSTF) recommends clinicians talk to these men about the potential benefits and harms of screening. For men aged 70 years and older, the USPSTF maintained the D recommendation, based on the position that the potential benefits of PSA–based screening do not outweigh the harms, and these men should not be screened for prostate cancer.

What changed the recommendation? Dead bodies one could presume. Dead male bodies. But under the ACA that was irrelevant.

The data upon which the based their analysis is in my opinion flawed. They state that of 1,000 men screened, 240 received a positive result and 100 were found to have PCa. If screening had been done then 2 lives would be saved. First the screening was done several years apart! That is non-sense. PSA testing demands annual tests with velocity being measured. The analysis grossly misrepresents the facts in my opinion. No genetic analysis is performed. It is well known that about 5-10% of PCa is aggressive, the remaining is non life threatening. Thus one would expect a small percent death but  finding that small but critical segment is not done by random and intermittent testing.

At some point those who deal with this every day on both the clinical and research level should become part of the panel, and a key part. We are in my opinion poorly served by this organization.

Finally, the USPSTF again disregards anyone over 70! That is just another way to "let the old folks die!" of the ACA.