When the news broke earlier this week about two studies in the Journal of the American Medical Association that showed fewer men were getting screened for prostate cancer (and that fewer early stage cases were being detected), a lot of people might have been surprised.
Dr. Scott Miller was not.
Dr. Miller has long disagreed with the U.S. Preventative Services Task Force recommendations, which were deemed to be the reason for the fall-off in screenings and early detections. Dr. Miller sees the Task Force recommendations as arbitrary. The Task Force was concerned with “overtreatment”; thus, it advocated less screening. Dr. Miller said he sees that reasoning as illogical, as peoples’ lives are at stake.
In 2012, the Task Force issued a recommendation against PSA screening. (PSA is a protein in the blood produced by the prostate; high PSA levels can indicate an individual is at higher risk for prostate cancer.) In addition to the Task Force, a number of organizations, including the National Comprehensive Cancer Network and the American Cancer Society, issue contradictory guidelines.
Dr. Miller, who has been a leader in the Atlanta medical community when it comes to prostate cancer issues, said this can lead to confusion.
“The position that I come from is that you have all these major organizations giving a bunch of different recommendations so the patient is receiving mixed messages,” said Dr. Miller, who founded the nonprofit group ProstAware to create greater awareness in metro Atlanta regarding prostate cancer. “And that’s what the primary care physicians also are hearing. Those are the people at the front line for cancer screening. Patients typically don’t go to urologists for cancer screenings, it’s only a small percentage. Most of the screening is done out in the community by primary care physicians. So to make that message more concise, once a man reaches age 40, they should learn about their risks of dying from prostate cancer and their need for screening. In essence, this approach encompasses all of those recommendations by the various organizations.
“If you take one of the organizations that says men should start receiving screening at age 50 but earlier for higher-risk groups, how do you know if you’re in a higher-risk group if the message you’re getting is the media bite or the sound bite that says most men don’t need screening?”
Dr. Miller believes that more education is the answer.
“Be informed of the risks of screening and of not screening,” he said. “Patients should have a role in that decision but it shouldn’t be so cumbersome that it doesn’t even make it logistically possible. As for the role of the primary care physician in this discussion, they have a lot of balls in the air when a patient comes in their office. Even if you have a healthy patient, you have to look at their blood pressure, their sugar, their lipid panel, and their lifestyle – not to mention their other screening needs such as colonoscopy. If the primary physician has to look at all of these things, how can they have that three-to-five minute conversation with every single patient about prostate cancer screenings? They really can’t.”
As an editorial accompanying the studies in the Journal of the AMA said, the pendulum has swung too far away from getting men tested. No surprise, then, that the Task Force already has begun a review process.