USPSTF institutes period for public comment on draft guidelines

Apparently the U.S. Preventive Services Task Force (USPSTF) has learned a little about communications from the chaos that accompanied the announcement of new guidelines for breast cancer screening in November 2009.

In announcing new draft guidelines for the screening of women for osteoporesis if they are aged 65 or older, or if they are younger but have an equivalent risk of a fracture, the USPSTF has built in a 4-week period for public comment and has stated that all such comment “will be considered fully” before the guidelines are finalized.

According to an article on the Wall Street Journal‘s Health Blog, the USPSTF had already tested this process and had already been planning to implement it at an unspecified future date. Supposedly, the breast cancer furore merely “prompted  an early implementation of the new policy.”

Historically, the USPSTF has simply issued their guidance along with publication of a review of the evidence used as the basis for their decision. This small step of allowing for public comment is at least a movement in the right direction.

Another problem with the USPSTF guidelines has long been the way they are phrased. The nature of the guidance has clearly resulted in people “receiving” messages that the USPSTF claims they do not mean to send. In the case of the breast cancer screening guidelines, the USPSTF was told by a number of doctors before the issuance of the guidance, that their intended message of “Women in their 40s should talk to their physician about when to begin regular mammography” would be misconstrued as “Women in their 40s should not get mammograms, period.” This proved to be true, and the breast cancer community reacted with full force.

Arguably, this is the same sort of problem as the recommendation statement from the USPSTF about the use of PSA testing for men > 75 years of age, which reads, “The USPSTF recommends against screening for prostate cancer in men age 75 years or older.” It is easy to see how this statement would be misconstrued to suggest that, “No one over 75 years of age should get a PSA test.” (Although some may be of the opinion that that is exactly what the USPSTF intended to communicate.)

Hopefully, by the time that the USPSTF revisits its guidance on prostate cancer screening, its members will have found a way to suggest that there may at least be some men of > 75 years of age for whom PSA testing has a value — even if they still come to the conclusion that “the current evidence is insufficient to assess the balance of benefits and harms of prostate cancer screening in men younger than age 75 years.”

2 Responses

  1. It is really discouraging that the USPSTF has NO BOARD MEMBER with expertise in prostate cancer, based on their specialties, at least as of the last time I checked a few months ago. I suspect that little of their clinical time has been spent with prostate cancer patients.

    I’m convinced they fail to understand that prostate cancer is generally a slow-growing disease, and that has a profound effect on the follow-up time needed in research studies. I’m convinced they do not understand many of the complexities of prostate cancer.

  2. The truth is that all studies, including the recent one from Sweden, show that PSA screening is most valuable for younger men (50 – 55). There are two reasons for that: the cancer seems to be manifest itself as more aggressive at a younger age and the mortality is evidently lower.

    I don’t think USPTF tries to say that men over 75 should NEVER be PSA tested. It seems to say that the value of testing diminishes as the age progresses.

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