A prostate ‘Pep Talk’ is the wrong way to get men thinking about cancer screening

Alan Cassels is a drug policy researcher. He frequently reports on consumer drug issues and has authored and co-authored several books. He tweets as @AKECassels.

With September’s Prostate Cancer Awareness Month in full swing, an industry-affiliated partnership has turned to high-profile former NFL coaches to deliver its prostate cancer screening message. It’s a clever choice: professional coaches are good at getting men to do all kinds of things they might not otherwise want to do, whether it’s extra wind sprints at the end of practice or thinking about their prostate health. Their testosterone-laden “Pep Talk” exhorts men to put down their remotes, get off their couches and go avail themselves of a free (or discounted) PSA (prostate specific antigen) test to check for cancer.  

Here’s one of several videos produced for the campaign:

What’s wrong with a little motivation? This pushy Pep Talk runs counter to recommendations from just about all major medical organizations, who caution against routine screening for prostate cancer and say that the decision to undergo PSA testing should only occur after a discussion of benefits and harms with a health care provider.

“The screening decision is made best in partnership with a trusted source of regular care,” according to the American Cancer Society.

In contrast to those thoughtful recommendations, the Pep Talk website mindlessly urges men to “schedule a free screening” at a testing center, where the only medical professional they’re likely to encounter is a lab assistant with a syringe ready to draw blood. There’s no mention of any discussion of the benefits, risks, or long-term consequences of getting tested.

Because these issues deserve careful consideration, guidelines from the American Urological Association “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).”

News outlets help amplify a pro-screening message

The campaign, which is sponsored by the NFL Alumni Association, LabCorp and the Cancer Treatment Centers of America, has been covered by news outlets ranging from CBS Sports to the Marietta (Georgia) Daily Journal. A piece from Fox23News, the Tulsa, Oklahoma affiliate, featured former Seahawks star Steve Largent and Cowboys lineman Ed “Too Tall” Jones who kicked off the prostate cancer screening campaign at the Cancer Treatment Centers of America. Jones said that the early diagnosis of prostate cancer is essential: “They can either fix it or give you a better quality of life.”

While the message may be well meaning, Richard Hoffman, MD, MPH, director of the Division of General Internal Medicine at the University of Iowa Carver College of Medicine, believes the substance of these stories is all wrong. “It’s the equivalent of encouraging helmet-on-helmet tackling,” he says.

Hoffman notes that a helmet tackle may stop the runner but puts the player at risk of head injury and long-term cognitive dysfunction from chronic traumatic encephalopathy (CTE). Finding and treating prostate cancer also poses serious risks, Hoffman says; it shouldn’t be encouraged thoughtlessly with a pep talk:

“Unfortunately, the simplistic message to get screened ignores the many important downstream consequences. The prostate cancer screening equivalents of developing CTE from head trauma include the risks of false positives, harms from biopsies, risks for overdiagnosis and overtreatment, and treatment complications.”

Richard Hoffman, MD, MPH

Hoffman references Otis Brawley, MD, medical director of the American Cancer Society, who has raised concerns about free mass screenings at county fairs, shopping malls, and other public venues. These events are often sponsored by special interests seeking to attract new patients, Brawley says, but they don’t offer the opportunity to make informed decisions before testing.

Brawley criticized all the publicity surrounding such screenings, “some of it by people who want to make money by recruiting patients,” adding that such promotion “oversimplifies the issue by saying that prostate cancer screening clearly saves lives. The truth is if you are concerned about prostate cancer, understand there are proven risks and possible benefits…. Every man needs to decide for himself.”

Conflicts of interest behind pro-screening messages

Numerous groups have cautioned against routine PSA testing including the American Academy of Family Physicians (AAFP), the American Urological Association (AUA) and the US Preventive Services Task Force. Yet the disease mongering of our prostates continues as HealthNewsReview.org has demonstrated on numerous occasions. Why?

One of the biggest problems, never mentioned in these stories about the Pep Talk, is the unrelenting and substantial financial conflict of interest among those who are selling early detection. Maybe the NFL Alumni don’t have a deep interest in finding early cancers in men, but their partners sure do. LabCorp (net revenues $9.5 billion in 2016) makes money running screening tests such as PSA. The Cancer Treatment Centers of America (CTCA) is a for-profit treatment network of five US hospitals specializing in cancer care. These groups are in the business of discovering and treating whatever signs of cancer that present themselves, perhaps even the ones that may never go on to hurt you — which happens to be the majority of the cancers that are discovered through a PSA test.

Educating men should be the goal — not coercing them

Here’s what just about everyone who has an opinion about prostate cancer screening can agree on: Talk to your doctor. 

If the Pep Talk had revved men up to have an informed discussion with their health care providers about the benefits and harms of PSA testing, then we’d have nothing to criticize. We’d also have no problem with an effort to fully educate men about the data on prostate cancer screening and the likelihood of benefiting or being harmed by the intervention.

“The idea of having men turn to a trusted site to learn about screening is good—we should not expect primary care providers to be completely responsible for educating men about complicated screening decisions,” Hoffman says. It’s an issue Hoffman explored in more detail in a recent commentary in the journal Cancer.

“The goal is to EDUCATE men about screening,” he emphasizes, and “to make sure that they understand the benefits and harms of screening—not to give pep talks to coerce men into blindly making decisions that can adversely affect their health.”

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Bradley Flansbaum

September 26, 2017 at 6:23 pm

Hi Alan.
As always, thank you for the post.
Something to consider, and if anything, alters the calculus of PSA utility if the study stands up to time and scrutiny. I think it will change USPTF thinking when it comes time to reconsider recommendations.

The study got a lot of commentary inside the medical community–and from what I read–the reception was cautious but affirming.
http://annals.org/aim/article/2652567/reconciling-effects-screening-prostate-cancer-mortality-erspc-plco-trials#
It needs a look.
Brad

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Chris O'Neill

September 27, 2017 at 10:15 am

Unfortunately a large part of the medical profession still believes it is more important to PSA screen men without fully informing them than to fully inform them e.g. https://health.usnews.com/health-care/articles/2017-04-11/many-docs-dont-discuss-prostate-cancer-screening-pros-and-cons

If a large part of the medical profession still behaves this way, it makes it difficult to expect advocacy organisations to behave any better.

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