By Katherine Hobson
The United States Preventive Services Task Force has canceled a meeting set for early next month at which the thorny issue of prostate-cancer screening was due for a vote.
We heard of the cancellation and agenda from people planning to attend the meeting. And according to a PowerPoint presentation we saw, when prostate-cancer screening came up last fall, the USPSTF initially voted to recommend against screening for men of all ages before opting instead to re-vote on the issue.
USPSTF chairman Ned Calonge confirmed all that, saying the Nov. 1-2 meeting was scrubbed due to scheduling conflicts. “If we weren’t going to be able to get our work done, there was no reason to have a meeting,” he tells the Health Blog. The USPSTF consists of 16 members.
Instead, Calonge said he’s hoping to have a conference call to “keep the work moving forward” and then reconvene again in March for the next regularly scheduled meeting.
Currently the USPSTF has an “I” rating for prostate-cancer screening, which means the current evidence is insufficient to assess the balance of benefits and harms, for men younger than 75. For older men, the rating is “D,” which means the USPSTF recommends against screening. The group last issued recommendations in August 2008, but in 2009, results from two large screening trials were published. The studies provided no clear answer of whether the benefits of screening outweighed the harms — which include not just false positives, but the treatment (with attendant side effects) of cancers that never would have threatened a man’s health.
Because of that new info, the USPSTF brought up prostate cancer at its November meeting last year and, according to the slides shown to us by someone who attended the meeting, voted at first to give prostate-cancer screening a “D” recommendation for all age groups. Calonge said that as report was being written, the group decided that the possible harms of screening also needed updating. So the USPSTF “voted to re-vote,” he says.
As you may remember, it was also November that the USPSTF published its updated recommendations for breast-cancer screening, which quickly got caught up in the political maelstrom surrounding health-care-overhaul. The panel wasn’t prepared for the controversy created by its recommendation that women aged 40-49 who are at average risk of breast cancer should discuss the benefits and risks of screening with a physician rather than getting it as a matter of course.
Calonge says the mammography controversy erupted after the need to update information on the harms of prostate-cancer screening became clear but before the full task force decided to re-vote on its recommendations. “I believe we would have voted to reconsider regardless of the response,” he tells us via email.
The American Cancer Society updated its own prostate-cancer screening recommendations earlier this year, saying that there is still not enough evidence that routine screening makes sense. The group recommends that men talk with their physicians and weigh the “uncertainties, risks, and potential benefits” of screening starting at age 50. (Higher-risk individuals should consider the screening issue earlier, the ACS says.)
It’s not possible to say how a vote on prostate-cancer screening will go next March. A few members of the task force have finished their terms and have been replaced by new ones, and a more precise estimate of prostate-cancer screening’s harms could make any benefits seem comparatively large or small.
Whatever happens with the recs, they’ll go through the USPSTF’s new process, which includes posting of the draft recs on the group’s website and a subsequent four-week public comment period before the guidelines are finalized. The public comment “will serve so many good purposes,” including providing the opportunity to get the input of outside experts, Calonge says. “And it helps people to start to understand the system,” he says.
One of the reasons the USPSTF’s work has become so closely scrutinized is that the health-care overhaul bill requires that preventive services given an “A” or “B” recommendation by the task force will be fully covered by insurance. But Calonge says that coverage is never one of the issues in the task force’s discussion and that there’s no reason that full coverage of lesser-rated services couldn’t also be mandated. “There wasn’t a single person on the task force that felt that if a woman under 50 wanted to be screened” for breast cancer it shouldn’t be covered, he says.
He had no comment on whether the timing of the November meeting — overlapping with Election Day — played any role at all in its cancellation, though the group’s decision wouldn’t have been publicized for a while in any case.