Prostate Cancer Screening Challenged

 

Prostate cancer is the second leading cause of death from cancer in men, behind only lung cancer. According to The American Cancer Society, 220,800 new cases of prostate cancer were identified in 2015 and the disease accounted for 27,540 deaths. About 1 in 7 men will be diagnosed with prostate cancer in their lifetime.

With these alarming statistics, you would think there would be a strong push for prostate cancer screening in men. Yet recently, I was shocked to discover the opposite is true.

All medical doctors must take continuing medical education (CME) classes to keep their medical licenses active. Recently I took such a course called Cancer Screening. I was surprised to learn that prostate cancer screening recommendations have recently changed.

I’ve been receiving regular prostate screening since the age of 50 as recommended by my family internist as well as my urologist. Yet the correct answer on the CME exam I took is that there is no routine screening recommended for men who do not have a strong family history of prostate cancer.

A chart accompanying the course I took gave the following recommendations by medical society:

  • American Urological Association – No routine screening*
  • American College of Physicians – No routine screening*
  • American Cancer Society – No routine screening*
  • U.S. Preventative Services Task Force – No routine screening at any age
  • American Society of Clinical Oncology – No routine screening*
  • National Comprehensive Cancer Network – No routine screening*

* exceptions according to age and physician discussion

 

For men between the ages of 50 and 69 years most recommended a “discussion of the risks and benefits” of screening. Screening, when applied, consists of a digital rectal exam (DRE) and measurement of prostate specific antigen (PSA) blood levels. Thankfully, both of my doctors continue to recommend screening.

Here are some interesting facts to consider:

  • Medicare pays for an annual PSA test for men 50 and older as “preventative care.”
  • ObamaCare does not consider this “preventative care” and therefore does not cover it free of charge as it does mammograms.
  • The American Cancer Society does favor PSA tests for men over 50, and as early as 40 for men with more than one first-degree relative diagnosed with prostate cancer.

 

According to John R. Graham of The National Center for Policy Analysis, Medicare has commissioned a consulting firm to develop quality measures (to be collected by electronic health records) that will have an impact on physicians’ pay: those who order too many PSA tests will have their Medicare payments cut. (This is a by-product of the Medicare “doc-fix” that was passed by Congress earlier this year.)

Melinda Beck, writing for The Wall Street Journal, says this proposal is part of an Obama administration effort to develop ways to identify and reward value in healthcare. They have said they plan to tie 50% of Medicare payments to such quality measures by 2018.

“PSA screening is a very controversial topic. The debate is ongoing and people feel very strongly about it, one way or another,” said David Penson, chair of public policy and practice support for the American Urological Association, which urged CMS to reject the proposal. “To make it a quality measure would say, ‘You’re a poor quality doctor if your patients get this test.’ ”

The alarming truth that is evident here is that the government is no longer content to let this issue be decided by your own doctor. They want to control the way your doctor practices medicine – so they can control the cost of healthcare. It’s a scary thought but one we can expect more often in this era of government control of healthcare.

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