Prostate Week continues: Yale Cancer Center also flouting evidence with public prostate screening event

It’s been a big week for prostate screening news and we’re not finished yet.

We fact-checked Donald Trump’s health sit-down with Dr. Oz and explored the misleading messages it produced about prostate-specific antigen (PSA) testing.

We looked at coverage of a new clinical trial showing that active monitoring in screen-detected early prostate cancer produces outcomes very similar to aggressive treatment with radiation and surgery.

And finally, we looked at the Roswell Park Cancer Institute’s “Cruisin for a Cure” event, which exhorts men to get screened even though all major medical organizations recommend against routine screening.

That last post may have prompted a knowledgeable reader to contact us with another promotion for a public screening event from Yale Cancer Center, which we pass along to demonstrate that Roswell Park is no outlier in its pro-screening boosterism.

The reader wrote to us: “Shameful, frankly. Against every major group’s recommendation. No conversation. No thought. Just get screened.”

The event was also plugged in a Yale news announcement that highlighted the participation of a local TV station and the fact that they were “promoting free prostate cancer screening.”

gil-on-the-go

In the body of the announcement, there is a quote from a Yale urologist who claims they are “keeping with recommendations of the American Urological Association,” and that “all men between the ages of 55 and 69 should be offered screening.”

Really? Those guidelines explicitly state: “Thus, we recommend against organized screening in settings where shared-decision making is not part of routine practice (e.g., health fairs, health system promotions, community organizations).”

The guidelines also state:

  • For men ages 55 to 69 years, the decision to undergo PSA screening involves weighing the benefits of preventing prostate cancer mortality in 1 man for every 1,000 men screened over a decade against the known potential harms associated with screening and treatment. For this reason, shared decision-making is recommended for men age 55 to 69 years that are considering PSA screening, and proceeding based on patients’ values and preferences.

If truly informed decisions were happening after a careful discussion of benefits and harms at this event, then there wouldn’t be anything to complain about. However, it’s hard to see how that can be happening when men are exhorted to “schedule a free screening” — not a “discussion” or “educational session” — with the hashtag “earlydetectionsaveslives.”

It’s also difficult to imagine shared decisions happening when a Yale urologist is quoted in television news stories about the event saying, ““If they make the commitment to be screened for it, they should do so with the optimism their efforts are going to pay off with good results.”

The complexity of the tradeoffs, and the nuance in the AUA guidelines, is not reflected in these simplistic messages that urge men to get screened.

How should the topic of screening be dealt with, if not at an organized free screening event?  Richard Hoffman, MD, MPH, a screening expert at the University of Iowa told me that in his view, the context for shared decision-making is best established by the 2010 American Cancer Society guidelines. “The screening decision is made best in partnership with a trusted source of regular care.”

Hoffman added, “Given the complexity and downstream consequences of these decisions, the discussions should not be to delegated to someone the patient may be meeting for the first time and may never see again.”

Speaking of risk communication and shared decision-making

This week our Publisher, Gary Schwitzer, has been meeting Gerd Gigerenzer and his team at the Harding Center for Risk Literacy at the Max Planck Institute in Berlin. Gary told me he’s working on opportunities for us to collaborate and involve the Harding team in our work.

I’ll get the ball rolling here by sharing their prostate cancer early detection fact box, which nicely breaks down the evidence in way that is accessible to the average person:

factsbox_psa_04-2014_en_0

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Comments (1)

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Ed Dwulet

September 16, 2016 at 5:32 pm

Very sad. PSA screening has been nothing but a profit driven public health disaster. It was simply widely implemented as a good idea “on paper” before it was adequately vetted as effective. But some smart people saw it for what it was 20 years ago. The article linked below was written by a Stanford M.D. and Prof of Medical Ethics in 1996 … 1996! He strongly warned about the inadvisability of using PSA testing as screen for prostate cancer. No one listened — and he had to go to India to find a medical journal to publish his concerns. (Although I’ve looked hard, I haven’t been able to find an American Journal of Medical Ethics — possibly because ethics has gone out the window and profits rule the day here in our “best medical system in the world.” The “PSA era” continues to ruin the lives of many men and it has harmed millions over the past 20 years. All of Dr. McCaulley predictions have come true. Please read:
“The great American pseudo-epidemic of cancer of the prostate”
http://www.issuesinmedicalethics.org/index.php/ijme/article/view/1765/3803