More about screening … current and future issues

So there are two new articles recently published on the prostate cancer screening issue. One deals with the numbers of men  in America who seem to be getting screened today. The other addresses whether there should be different guidance on prostate cancer screening for African Americans as opposed to “the rest of us” (Caucasians, Hispanics, and “white” Americans).

In the journal JAMA Internal Medicine this week there is a research letter by Fedewa et al. (from the American Cancer Society) that basically indicates that rates of PSA-based prostate cancer screening among men of 50 years and older were at about 38 percent in 2010, then dropped to 31 percent in about 2013 (after the US Preventive Services Task Force or USPSTF had issued a level D recommendation suggesting that screening for prostate cancer with the PSA test was inappropriate. A consumer-directed summary of this article is already available on the HealthDay web site

As of 2015, Fedewa and her colleagues say that the PSA screening rate appeared to have stabilized and was at about 32 percent in men of 50 or older. We’ll have to wait to see what happens if and when  the newest set of recommendations from the USPSTF are finalized later this year (i.e., that men of 50 and older should discuss the risks and benefits of PSA testing with their doctors and come to a shared decision in individual cases).

In a separate article in the journal Cancer, Tsodikov et al. address the issue of whether the higher rates of incidence and mortality from prostate cancer among African American men  as opposed to other racial groups in America warrant different guidance on prostate cancer screening for this subset of the population. This article is also addressed by commentary on the HealthDay web site.)

One of the real problems with this question is that we have very limited data on the effectiveness of screening for prostate cancer among African Americans and so we really don’t know whether screening in this population would be able to lower rates of metastatic disease, prostate cancer-specific mortality rates, or perhaps even overall mortality rates among African Americans.

Tsodikov and his colleagues applied three different statistical models to  project that:

  • Between 30 and 43 percent black men in the US will develop preclinical prostate cancer by the age 85 years.
  • This level of risk is (relatively) 28 to 56 percent higher than the risk for the general male population of the US as a whole.
  • Among the men with preclinical prostate cancer, black men had a similar risk of actual diagnosis with prostate cancer (range, 35 to 49 percent) compared with men in the general population (range, 32 to 44 percent), but
  • The risk for progression to metastatic disease by the time of diagnosis among African American men was 44 to 75 percent higher compared to men in the general population.

The authors conclude that:

Prostate cancer incidence patterns implicate higher incidence of preclinical disease and higher risk of metastatic progression among black men. The findings suggest screening black men earlier than white men and support further research into the benefit-harm tradeoffs of more aggressive screening policies for black men.

The “New” Prostate Cancer InfoLink would point out that the most recent draft guidance issued by the USPSTF also called out the need for more research into screening of men in the African American community, and stated the following as being one of the critical “research gaps” in our current knowledge:

Screening for and treatment of prostate cancer in African American men, including understanding the potential benefits and harms of different starting ages and screening intervals and the use of active surveillance; given the large disparities in prostate cancer mortality in African American men, this should be a national priority.

There seems to be some real consensus around this issue. However, funding such research in the current political environment may be a much more complicated issue.


4 Responses

  1. I dont understand what the “risk ” of PSA testing is … It is just a simple blood test … doesn’t even require fasting. Is it more what the PSA score leads to that is the “risk” … decisions to perform biopsies, etc., leading to cancer diagnoses and perhaps treatment decisions which weren’t necessary due to the cancer fear of the patients?

    On Tue, Apr 25, 2017 at 9:51 AM, THE NEW PROSTATE CANCER INFOLINK wrote:

    > Sitemaster posted: “So there are two new articles recently published on > the prostate cancer screening issue. One deals with the numbers of men in > America who seem to be getting screened today. The other addresses whether > there should be different guidance on prostate cancer” >

  2. Yes. … Don’t you think that is a considerable risk for an lot of men who may not be as well informed as you?

  3. @Jerry: Research a bit the effects and costs of over-treatment … Diminishing, but still overwhelmingly greater than under-treatment of patients (in numbers: the “cost” ratio is too individual for me to go into).

    @Sitemaster: The parenthesis following “the rest of us” reads oddly. Removing the letters “cauc” improves it slightly: is that what was meant?

  4. Dear blogollum:

    No, the wording was very deliberate. There are now lots of “white” individuals whose genetic history is so muddled that all we really know is that they aren’t obviously African American. A typical example might be someone from the American southwest whose ancestry could very easily be something like a 25% Hispanic, 25% native Aztec or Toltec or similar, 25% native American, and another 25% of “not African American” of almost any type thrown in for good luck. Another individual from the American northwest might easily be 37% Chinese or Japanese; 25% native American; and 37% Caucasian.

    Of course the same logic applies to many people who appear to be “black”.

    Your sitemaster is actually beginning to find the division of America into color- and language-based subgroups of people rather irritatingly inaccurate. Maybe we should all get a genetic profile from 23&Me or Ancestry or similar at birth so that we actually knew what we are and dump the outdated, racially biased, color- and language-based social profiling. Could we persuade the federal government to fund this important initiative? After all, they already have footprints for most of us at birth!


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