Despite thumbs down from professional groups, mass prostate cancer screening events continue, often with misleading promotions

Joy Victory is deputy managing editor of HealthNewsReview.org. She tweets as @thejoyvictory

cruisin-for-a-cure-2016-roswell-park-cancer-institute

Roswell Park Cancer Institute’s prostate cancer screening event.

[Editor’s note: Please see the comments section for a response from Roswell Park Cancer Institute and our reply.]

It’s hard to know what’s motivating the Roswell Park Cancer Institute in Buffalo, N.Y., to hold a prostate cancer screening event later this month, but we know what’s not motivating them: the evidence.

Their Sept. 24 sixth annual “Cruisin’ for a Cure” offers “complete, free prostate cancer screening for men at least 40 years old.” It’s one of many prostate cancer screening events being held this fall, all across the country, that flout what the evidence shows–which is that the potential harms of PSA screening outweigh the benefits–and that contradict recommendations from major doctor groups–which call for a full discussion of the pros and cons of screening before administering the test.

This Roswell Park event in particular caught our eye because, in the past, this institution has trotted out misinformation about prostate screening while offering prizes like free hockey tickets to men who joined their “Prostate Club.”

Despite getting called out for it (see link above), they’re doubling down on this misguided approach, this time with a car show event promoting a “cure” for prostate cancer. Far from offering any cure, however, the event seems to be about recruiting men for screening in ways that don’t conform with national recommendations.

Men with prostate cancer who receive treatment following a PSA screen way well believe themselves to be “cured” of a horrible disease. But as the evidence clearly shows, many healthy men who are screened also will undergo unnecessary, potentially harmful biopsies due to the test’s high false-positive rate. Others will be treated for cancers so slow-growing that they would never cause a problem during the man’s lifetime. Cancer treatments can expose these men to host of urinary and sexual side effects for no good reason.  

‘These … screening events are discouraged by just about every professional organization’

“This [event] may be well intentioned (but ill informed) or it might be an attempt to increase revenue by finding more cancer cases,” said Doug Campos-Outcalt, MD, a contributor to our site who has served as a scientific analyst for the American Academy of Family Physicians and as the AAFP liaison to the United States Preventive Services Task Force (USPSTF).

“Regardless of the motive, these types of screening events are discouraged by just about every professional organization with a dog in the fight, including those that still see value in PSA testing,” he said.

Groups that have come out against routine PSA screening include the AAFP, the American Urological Association (AUA) and the USPSTF.

What should happen, if not a screening event?

Instead, what might be more useful at these events is not actual screening, but opportunities for men to have discussions with clinicians to more fully learn the benefits and risks of screening.

Everyone agrees that men should be well informed about the significant risks and unlikely benefit of being tested before obtaining the test,” Campos-Outcalt said.

Will men be told about those risks before being screened at the Cruisin for a Cure event? There’s no mention of potential risks or limitations of the test, or anything but pro-screening advocacy, on the website.

And while the site does reference the availability of “one on one education,” it’s difficult to imagine an informed discussion happening when men are already pre-registered for their “FREE Prostate Cancer Screening.”

Not just a man’s problem, either

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The image that ran with the Roswell Park Cancer Institute’s tweet promoting an upcoming prostate screening.

In the months and years ahead, we very well may see similar dial back from physician groups when it comes to routine pelvic exams for women.

As the USPSTF announced this summer in a draft update to their guidelines, there’s simply not enough evidence on the table to support the use of routine pelvic exams in healthy, non-pregnant women–especially not without a patient-doctor discussion about the known and unknown pros and cons.

“The value of routine pelvic exams (not Pap smears) is questionable and for sure unproven,” Campos-Outcalt said.

But that’s not the message from Roswell Park, which tweeted last week promoting the upcoming screening–by unfortunately equating pelvic exams with PSA tests and implying that both help patients “take control of their health.”

“Women have been having Pap smears and pelvic exams for years,” the Tweet’s pull-quote says. “It’s time for men to also take control of their health by having a prostate exam and a PSA test.”

We’d argue it’s time to get up to speed with the evidence, instead.

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Comments (2)

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Annie Deck-Miller

September 15, 2016 at 4:19 pm

The article posted on HealthNewsReview.org on Sept. 14 about prostate cancer screening events was based on both misinformation and misunderstanding, and it’s important that we have the opportunity to clarify key issues.

Evidence is exactly what motivates Roswell Park Cancer Institute’s participation in Cruisin’ for a Cure, the signature event of the volunteer prostate cancer awareness and advocacy group MANUP Buffalo. For six years, MANUP and Roswell Park have partnered on this free community event as part of our shared commitment to address the following facts:

• Prostate cancer incidence in Erie County, NY, which includes the City of Buffalo, where the Institute is based, is 43% higher in African-American men than Caucasians, and mortality from prostate cancer in the county is 166% higher in African-American men than Caucasians. Similar disparities exist nationally.
• Deaths due to prostate cancer in America are nearly half what they were before the introduction of the PSA test, a shift that can be explained by no other factor than the use of PSA testing for early detection and to guide case management.
• Cruisin’ for a Cure aims to engage the 30.9% of people in Buffalo who are living below the poverty level, a status that has been clearly correlated with poor health and poor access to health care.

A member of the National Comprehensive Cancer Network and contributor to many national cancer guidelines, Roswell Park — like most comprehensive cancer centers — follows the NCCN’s prostate cancer early detection guidelines, which recommend initial or “baseline” PSA testing at age 50 for men at normal risk of developing the disease and beginning as early as age 40 for those at high risk — a group that includes all African-American men.

We are proud to partner with MANUP on this annual event, which is not one of the “mass screenings” derided in the Health News Review article but is instead an important early detection opportunity targeted at those who are disparately affected by high-risk prostate cancer and/or poor access to health care. We highlight in our communications the one-on-one educational consultation that is offered for any man 40 or over who attends this event — conversations in which we outline both the strengths and the limitations of PSA testing, including the fact that PSA can alert us to slow-growing, nonaggressive prostate cancer that may not ever need to be treated, as well as the risks associated with prostate biopsies. We repeatedly emphasize that the decision to have a PSA test to detect prostate cancer is one that is personal and should be made only after careful consideration and consultation with an informed physician.

This kind of outreach, which enables informed decision-making and improves access to evidence-based, guideline-compliant health care, is an essential part of a comprehensive cancer center’s mission and obligation to the community it serves.

However well-intentioned the recommendations on PSA testing cited by Health News Review — from the United States Preventive Services Task Force, American Urological Association and American Academy of Family Physicians — are, they do not reflect in any way consensus among health care providers and health policy makers, and we have serious concerns about the impact on public health in Buffalo and many U.S. communities if patients and physicians were to abide by them. There is already evidence that a recent decline in prostate cancer early detection is associated with an increase in cases of advanced prostate cancer that has spread to other organs.

Our participation in events focused on awareness, education and early detection of cancer is based on the documented need in the community around us, and wholly consistent with NCCN guidelines.

We don’t want to see a return to the days of just a few decades ago, before PSA testing, when the vast majority of men with prostate cancer were diagnosed only at late stages, when no effective treatment could be provided and symptoms caused significant pain and impact on quality of life. In the best interest of the community we serve, we will continue to work to improve access to cancer education and early detection for those who can benefit most from it.

— James L. Mohler, MD
— Willie Underwood III, MD, MSci, MPH

Department of Urology,
Roswell Park Cancer Institute

Links referenced above:

https://www.roswellpark.org/cruisinforacure
http://www.manupbuffalo.net/
https://www.health.ny.gov/statistics/cancer/registry/table4.htm
http://www.cancer.org/research/cancerfactsstatistics/cancer-facts-figures-for-african-americans
http://jco.ascopubs.org/content/early/2016/06/15/JCO.2016.68.2138.full
http://www.aafp.org/about/policies/all/policy-povertyhealth.html
http://www.nature.com/pcan/journal/vaop/ncurrent/full/pcan201630a.html
https://www.nccn.org/professionals/physician_gls/f_guidelines.asp
https://www.roswellpark.org/james-mohler
https://www.roswellpark.org/willie-underwood-iii

    Joy Victory

    September 16, 2016 at 10:12 am

    Thank you for your thoughtful reply.

    Our viewpoints on your comments:
     
     
    “Deaths due to prostate cancer in America are nearly half what they were before the introduction of the PSA test, a shift that can be explained by no other factor than the use of PSA testing for early detection and to guide case management.”

    Statistics on prostate cancer cases was not under debate in our blog post–it was the merits of public screening events using a test that has a high false-positive rate. However, there are many things to consider when discussing these statistics, versus simply attributing it to a single screening test, as noted in this modeling analysis quantifying the role of PSA screening in the US prostate cancer mortality decline. Keep in mind, also, that the US age-adjusted prostate cancer specific death rate is more or less the same as most Western countries that do much less screening than we have done and are doing.

    What’s under debate in our post is the promotion and use of the PSA test in a public setting like a car show. A far better setting to administer the PSA test is in a shared-decision making setting with a healthcare provider who has been providing or can provide regular care, knows the patient’s medical and family history, and who is in a position to follow the patient should active surveillance make the most sense, versus more invasive, aggressive, and potentially harmful treatments–such as radiation and surgery–that may not be needed.

    This line of thinking is echoed by the American Urological Association, which states in its guidelines: “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).”

     

    “A member of the National Comprehensive Cancer Network and contributor to many national cancer guidelines, Roswell Park — like most comprehensive cancer centers — follows the NCCN’s prostate cancer early detection guidelines, which recommend initial or “baseline” PSA testing at age 50 for men at normal risk of developing the disease and beginning as early as age 40 for those at high risk — a group that includes all African-American men. We are proud to partner with MANUP on this annual event, which is not one of the “mass screenings” derided in the Health News Review article but is instead an important early detection opportunity targeted at those who are disparately affected by high-risk prostate cancer and/or poor access to health care.”

    The Buffalo health system should be lauded for looking at community issues and trying to address them. Physicians we spoke to about this recommend that rather than mass screening events the health system would better serve the community by developing a more comprehensive primary care system, including involving more specialists in preventive medicine. That’s because in-depth discussion of prostate cancer screening involves a lot of time per patient and a public screening event is not conducive to this.

    On that note, you stated:

    “We repeatedly emphasize that the decision to have a PSA test to detect prostate cancer is one that is personal and should be made only after careful consideration and consultation with an informed physician. This kind of outreach, which enables informed decision-making and improves access to evidence-based, guideline-compliant health care, is an essential part of a comprehensive cancer center’s mission and obligation to the community it serves.”

    This is an admirable goal, but it is not reflected in your communications on social media so far; for example, urging men to “to take control of their health by having a prostate exam and PSA test.” This is not the kind of message that encourages “careful consideration” of the test’s benefits and risks. To the contrary, it suggests that event organizers have a strong bias in favor of PSA screening and that men who attend the event already pre-registered for a screening will be urged to go through with it.