Men’s Health Week should improve decision-making aspects of its campaign

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This week has been proclaimed International Men’s Health Week – the week leading up to and including Father’s Day. And it’s part of what’s more broadly been proclaimed by some as Men’s Health Month.

prostateforweb.jpgThe campaign offers a variety of men’s health “materials” – including the squeezy prostate stress ball pictured at left – if you’re into that kind of thing.

There are also brochures like the one at right. PCa_2007_300dpi.jpg The “Facts About Prostate Cancer” state that men at high risk should begin yearly screening at age 40 – all others at age 50. The “should begin (at 50)” recommendation crosses a line not supported by the US Preventive Services Task Force and the American Cancer Society, among other organizations.

The campaign also commits fear-mongering with these statistics:

1 in 6 men will get prostate cancer and approximately 28,000 men will die from the disease this year.

There’s nothing inaccurate about that. It’s just the framing and lack of context that is concerning. 1 in 6 – or about 16% is a lifetime risk – 16% of men born today will be diagnosed with prostate cancer at some time during their lifetime. But the National Cancer Institute reminds us that “Sometimes it is more useful to look at the probability of developing prostate cancer between two age groups. For example, about 8% of men will develop cancer of the prostate between their 50th and 70th birthdays.” And the lifetime risk of dying from prostate cancer, according to the American Cancer Society, is more like 1 in 36.

This is what such campaigns tend to do – use the scariest numbers to “heighten awareness.”

Such promotions might help more men if they spent more time discussing the poor quality of shared decision-making that takes place around prostate cancer issues. The DECISIONS survey found that “most prostate cancer screening decisions did not meet criteria for shared decision making because subjects did not receive balanced discussions of decision consequences, had limited knowledge, and were not routinely asked for their preferences.”

Dr. Len Lichtenfeld of the American Cancer Society wrote last year:

“The American Cancer Society does not recommend routine screening for prostate cancer, and has not since 1997. There is simply insufficient and conflicting evidence to say whether or not PSA tests really make a difference and save lives. Some evidence says, “Yes it does,” other evidence says, “No it doesn’t,” and some evidence is still too early to say for certain one way or another.

Bottom line, this picture is not clear so we can’t say yes or no as to whether or not screening is right for you.

So what do you do?

You and your health professional need to have a talk about the pros and cons of screening. You need to understand the possible benefits and harms, and what the evidence shows. Then you can make an informed decision about what is right for you. You may weigh the evidence and conclude that you want to be screened with a PSA test, or you may weigh the evidence and say that you don’t. And if you can’t make up your mind, the guidelines recommend that your health professional take your personal considerations into account and make the decision for you.

“But wait a minute,” you say. “I go to my doctor or other health professional for an office visit these days, and I am lucky if I get to say hello before she/he moves on to the next patient. How the heck are we going to have that discussion? Great theory; lousy practice.”

That’s where the modern age of technology comes in.

There are a number of valuable decision aids available on the internet which have been shown to make the process more reasonable and efficient–and allow you to move at your own pace in learning about prostate cancer screening benefits and risks.

“But wait another minute: my local hospital has free screening. Isn’t that a reasonable thing to do? Just go to my local grocery store parking lot, find the PSA van when it is there and get a test? Why shouldn’t I do that?” you might ask.

Here’s where we are probably at odds with a number of people who believe they are doing good by giving men mass screening in convenient locations.

Our guidelines are pretty straightforward on that one: unless you are someone who simply has no other access to medical care because you can’t afford it, mass screening doesn’t offer individualized counseling and education about the benefits and risks of PSA testing, so it should not be offered. And for communities that are disadvantaged, an effort must be made to provide that education and follow-up.

In other words, in our opinion, mass screenings at health fairs, or local parking lots or wherever are not a good idea. They certainly don’t meet the recommendations in our guidelines that men have a direct discussion with their health care professional to discuss benefits, risks and harms of screening for prostate cancer.”

Such context, depth, and emphasis on shared decision-making is absent in the Men’s Health Week promotion. It’s well-intentioned. But the road to fear-mongering is paved with good intentions. And it may not lead to truly informed decision-making.

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