Most “top-rated” web sites advocate shared decision-making about screening

Despite the recommendations of the USPSTF and others, “Only 17 percent of top-ranked consumer health websites advise against screening for prostate cancer” according to a paper just presented by researchers at the the 2014 Clinical Congress of the American College of Surgeons (ACS), currently ongoing in San Francisco.

The presentation by Zhao et al. (see this media release from the ACS) documents that:

  • They conducted Internet searches using the term “prostate cancer screening” through the three most widely used search engines (Google, Yahoo!, and Bing)
  • They reviewed information on the 29 distinct “top-rated” web sites identified on the very first page of web search results for each search engine, with seven sites common to all three search engines.
  • All 29 web sites were assessed for type of site host, accuracy of content, and screening recommendations.
    • 11/29 sites (40 percent) were from US commercial media.
    • 10/29 sites (34 percent) were from US government sources
    • Of the other eight sites, four were from health organizations, three from academic institutions, and one from a non-US government (the United Kingdom).
  • In the opinion of the authors, only one site presented incorrect information about prostate cancer screening (and this was one of the commercial information sources).
  • With respect to actual recommendations for or against screening for risk of prostate cancer,
    • 19/29 sites (66 percent) “advocated that men make an informed decision about prostate cancer screening after discussing the individual risks and benefits with their health care provider.”
    • 5/29 sites (17 percent) recommended against screening for prostate cancer.
    • 5/29 sites (17 percent) made no recommendation one way or another.

The lead author, quoted in the ACS media release, is clear that, in his personal opinion, informed decision-making about screening after discussion with a healthcare provider is the most appropriate strategy given the currently available data:

I think that’s the right approach and the one being advocated by most health care organizations. Zero screening is not backed up by good scientific evidence. PSA screening has drawbacks, but it’s the best modality we have at this point to detect prostate cancer early.

We should be equally clear that Dr. Zhao is a urologist currently practicing on Long Island, NY, who conducted this research while he was a resident at the Rutgers–Robert Wood Johnson Medical School, New Brunswick, NJ. We should also be clear that (unsurprisingly) The “New” Prostate Cancer InfoLink does not appear on the first page of Google, Yahoo!, or Bing if one does a search for “prostate cancer screening”.  However, we do sometimes turn up on the first pages of these search engines if one does other types of search on specific topics — and yes, we are “blowing our own horn” just a tad!

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