The US Preventive Services Task Force is the guardian of the federal coffers. Breast screen escaped, and the ladies will bloody well not brook any interference. Men, on the other hand, are such wimps that USPSTF is determined not to make that same mistake. “Evidence-based medicine” (more accurately, “economy-based medicine”) is the medical mantra, and its evaluation is subject to parameters that can only be described as biased.

Case in point: Brawley et al. set great store by reduction of mortality rate as the acid test of efficacy of screen. They point to many studies, usually denigrating them as flawed. But somehow the SEER statistics are ignored when it comes to prostate cancer mortality:

The 1975-2006 SEER age-sdjusted US mortality rates for prostate cancer represent a continuum from before aggressive screening, though the introduction of the PSA test, to a fully matured result of the aggressive screening era with the PSA test as the lead. The mortality rate peaked at 1993 at 39.400 per 100,000 population and has declined every year since, now 23.5600 per 100,000 in 2006. This is a 40.355% reduction in mortality from prostate cancer.

If mortality is the proof Brawley et al. seek, how do they explain this dramatic decline of mortality rate from statistics gathered during the aggressive screening era?

Is it cost-effective? That is another question, one that can get very subjective when seen through the eyes of the survivors, even more when seen by the families of those who didn’t survive, especially if they were dissuaded by learned medical people from being screened and educated and offered their own decisions.

As the watchman of the federal dollars, USPSTF is doing its job by discouraging screening and aggressive treatment. “It’s the economy, stupid,” to borrow a phrase from an old presidential campaign.

It also might be better if the government guidelines on screening were what political decisions are based on.

I am concerned that early detection for prostate cancer may be excluded for coverage if they use the USPSTF guidelines. As Mike said in the original post, men should have a choice. It seems wrong to take something away from men because there have been inadequate trials/studies to justify a higher grading.

In what Medicoutopia would that happen? I can’t see it unless a law were passed.

That update may be as controversial as the prostate cancer document, since there are now plenty of authorities that dispute that viewpoint. You might want to look at the commentary on this topic on the Breast Cancer Action web site, as well as BCA’s policy on breast cancer screening and “early detection”. These statements are from a breast cancer group that “carries the voices of people affected by breast cancer to inspire and compel the changes necessary to end the breast cancer epidemic.” We can reasonably assume that they would be recommending any test that they thought worked.

You got that absolutely right!

Manny

I could not care less whether Dr. Otis Brawley agrees or disagrees but when he speaks as the chief medical officer of the American Cancer Society he assumes the responsibility of an authority whose statements may encourage high-risk men to do nothing.

Phil Olsen