Has there been an increase in the discussion of advantages and disadvantages for PSA screening of prostate cancer from 2000 to 2010?
Kimmie, Crystal Ann
MetadataShow full item record
Purpose: Historically, men have received PSA tests in primary care without comprehensive discussions with their providers about the harms and benefits associated with cancer screening. We explore whether primary care providers have altered their discussion with their patients to discuss PSA screening in more detail following availability of evidence from two large screening trials about the potential harms of screening relative to its small absolute benefit. Methods: Data among men over age 40 from the cancer supplement to the nationally representative National Health Interview Survey was analyzed for 3,596 men in 2000, and 4,702 men in 2010, representing 25.5 million and 43.6 million Americans, respectively. Results: The age-standardized proportion of men reporting their provider engaged them in a discussion of PSA testing declined to 31.0% in 2010 from 38.0% in 2000 (p<0.001). More men reported receiving a PSA test in the past five years than reported having a discussion with their provider in both study periods, with the rate of testing declining to 44.4% in 2010 from 57.7% in 2000 (p<0.001). Testing rates and the frequency of discussions were highest among men over age 80, with 70.2% in 2010 reporting being tested in the past 5 years, and 49.5% indicating their doctor had discussed testing. Men in 2010 reported that 39.5% felt their provider recommended testing, 27.5% felt their providers discussed the advantage of PSA testing, while 14.1% indicated their providers discussed the disadvantages of testing. Conclusion: Despite an increased emphasis to more fully inform men about the harms and benefits of PSA testing, the frequency of these discussions in primary care has declined. When discussions do occur, providers are much more likely to highlight the advantages of testing. PSA testing is declining; however, testing remains highest among older men for whom some guidelines recommend against testing.
- Health services