United States Preventive Services Task Force - impact on screening.

[pjoshea13]

New study below.

Interesting that:

"There was a vast state-by-state heterogeneity, ranging from a relative 26.6% decrease in Vermont to 10.2% increase in Hawaii."

-Patrick

ncbi.nlm.nih.gov/pubmed/290...

Urology. 2017 Oct 19. pii: S0090-4295(17)31093-2. doi: 10.1016/j.urology.2017.08.055. [Epub ahead of print]

State-by-State Variation in Prostate-Specific Antigen Screening Trends Following the 2011 United States Preventive Services Task Force Panel Update.

Vetterlein MW1, Dalela D2, Sammon JD3, Karabon P4, Sood A2, Jindal T2, Meyer CP5, Löppenberg B6, Sun M7, Trinh QD7, Menon M2, Abdollah F8.

Author information

1

Center for Outcomes Research, Analytics, and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan, USA; Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

2

Center for Outcomes Research, Analytics, and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan, USA.

3

Center for Outcomes Research, Analytics, and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan, USA; Division of Urology and Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, Maine, USA.

4

Center for Outcomes Research, Analytics, and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan, USA; Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan, USA.

5

Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

6

Center for Outcomes Research, Analytics, and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan, USA; Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany.

7

Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.

8

Center for Outcomes Research, Analytics, and Evaluation, Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan, USA. Electronic address: [e-mail].

Abstract

OBJECTIVES:

To evaluate state-by-state trends in prostate-specific antigen (PSA)-screening prevalence after the 2011 United States Preventive Services Task Force (USPSTF) recommendation against this practice.

METHODS:

We included 222,475 men that responded to the Behavioral Risk Factor Surveillance System 2012 and 2014 surveys, corresponding to early and late post-USPSTF populations. Logistic regression was used to identify predictors of PSA-screening and to calculate the adjusted and weighted state-by-state PSA-screening prevalence and respective relative percent changes between 2012 and 2014. To account for unmeasured factors, the correlation between changes in PSA-screening over time and changes in screening for colorectal and breast cancer were assessed. All analyses were conducted in 2016.

RESULTS:

Overall, 38.9% (95% CI=38.6% - 39.2%) reported receiving PSA-screening in 2012 vs. 35.8% (95% CI=35.1%-36.2%) in 2014. State of residence, age, race, education, income, insurance, access to care, marital status, and smoking status were independent predictors of PSA-screening in both years (all P<0.001). In adjusted analyses, the nationwide PSA-screening prevalence decreased by a relative 8.5% (95%CI=6.4%-10.5%;P<0.001) between 2012 and 2014. There was a vast state-by-state heterogeneity, ranging from a relative 26.6% decrease in Vermont to 10.2% increase in Hawaii. Overall, 81.5% and 84.0% of the observed changes were not accompanied by matching changes in respective colorectal and breast cancer screening utilization, for which there were no updates in USPSTF recommendations.

CONCLUSIONS:

There is a significant state-by-state variation in PSA-screening trends following the 2011 USPSTF recommendation. Further research is needed to elucidate the reasons for this heterogeneity in screening behavior among the states.

Copyright © 2017. Published by Elsevier Inc.

KEYWORDS:

Advisory Committees; Cancer Screening; Guidelines as Topic; Prostate Cancer; Prostate-Specific Antigen

PMID: 29056579 DOI: 10.1016/j.urology.2017.08.055

[Hidden]

26.6% decrease in Vermont to 10.2% increase in Hawaii." ? Conclusion, quit surfing and start skiing. That must be the reason. Either that or stop rubbing pineapple juice on your feet and increase the amount of maple syrup applied between your toes. I once read that the Mahican Indian tribe in Vermont used to apply maple syrup on their genital area to prevent sexually transmitted diseases. For the life of me I can't think of any other logical conclusions.

[cesanon]

1. Healthcare is a regional business.

2. Different states have different ecosystems of how insurance companies interact with physicians.

3. In some states the pressures on Docs to strictly follow protocols are greater or lesser.

4. Unless things have changed recently, the officially accepted protocol is not to do early PSA testing.

5. If the preponderance of Docs in a state are following that protocol, you would expect to see fewer tests... and vice versa.

I do not recollect specific examples, but there are other regional variations in patterns of medical practice that can't be justified based on medical science (same diseases/conditions and same patient population) but are based upon local medical economic forces and practices.

[Hidden]

My new GP is part of the faculty at the local college of medicine. He toed the (stupid) line and refused to include PSA testing in my annual physical blood work, despite my age being 66 at the time. After some nagging on my part he finally administered the DRE the third time I saw him (thought this would be done at first appointment). That was suspicious and he sent me off to a urologist. The urologist asked: what did the PSA test reveal? I had to then get that test and it came back only 2.7. I think it is dumb to not include an easy, cheap test to screen for prostate cancer especially for a male over the age 60. I am in Arizona.

[j-o-h-n]

"Mahican Indian tribe in Vermont used to apply maple syrup on their genital area to prevent sexually transmitted diseases".

I wonder what they used on their pancakes?

j-o-h-n Wednesday 10/25/2017 6:04 PM EST

[Hidden]

No way would I recommend that anyone adhere to this elitist group's recommendation. Ever study the make up of the task force? Not one Prostate Cancer Specialist on it - no Urologist, no Oncologist. Instead the make up consists of: four General Internists; three Pediatricians; three Family Medicine; two Obstetics/Gynecologists; one Epidermiologist; and three PhDs.....

would anybody in this group trust anyone of these people to treat their Prostate Cancer, Advanced or not?

Gourd Dancer