Prostate Cancer Screening: The Latest Evidence To Be Ignored?

Ladies and gentleman, please be seated. Let the emotional debate begin anew.

The U.S. Preventive Services Task Force has provided us with new recommendations regarding PSA-based screening for prostate cancer. Based on the evidence reviewed, they no longer support screening for prostate cancer as “many men are harmed as a result of prostate cancer screening and few, if any, benefit”. In 2009, they had similar thoughts regarding breast cancer, noting that the USPSTF “recommends against routine screening mammography in women aged 40 to 49 years”.

I am sure all of this will have men and women alike up in arms. We should expect more cries of “rationing of care” and the like coming shortly.

Science-based medicine provides us with sound clinical guidelines upon which to build a foundation for care. That assumes, of course, that the science-based medicine in question isn’t simply going to be ignored. But as it stands right now, “although about half of primary care doctors agreed with the guidelines, less than 2% said they planned to actually follow them and completely stop using the PSA.”

Surely you jest. Really?

When I first read the news of the USPSTF findings, I was pleased. Evidence-based medicine wins! Evidence triumphs over the forces of beliefs …

Or does it?

There are some very intriguing statistics in the USA Today article, such as -

- 17% of doctors said they had ordered PSA tests in the past year without discussing it with patients;

- 75% of doctors said their patients expected them to continue to order PSA tests;

- 66% of doctors said it was more time-consuming to explain their reasons for not screening than to just give the test; and

- 26% of doctors were afraid patients would assume they were cutting costs.

So we now have two significant findings for breast cancer and prostate cancer screenings, and physicians who are choosing to ignore the clinical guidelines which are formulated to allow them to be more effective in their care. In the meantime, they are also deciding that, well, educating the patient in all of this just isn’t important.

I guess this makes sense after you read “How do you feel about Evidence-Based Medicine”. When you see comments like …

… “only 15% of what we do has any evidence base” …

… “It’s become the new religion” …

… “I see EBM as a way of “dumbing down” medicine to allow NP’s to try to practice medicine” …

… “EBM today is the quackery of tomorrow” …

… “Intuition based medicine, like art, is always about a century ahead of science” ...

… then you have reason to understand why the USA Today numbers shouldn’t surprise any of us.

Lest I remind you, the “intuition” of centuries ago claimed the earth was flat, but I digress.

The responses to EBM are always similar when the belief systems are broached. With that said, and to be fair, it is not just physicians that bristle when evidence-based medicine is discussed. We can find plenty of other health care professionals utilizing assessments or treatments that have little to no scientific evidence (or principle) to support them. But, they forge ahead nonetheless.

It is times like this that I am reminded of the quote -

“In God we trust, all others bring data”.

I would like my health care to be science-based, please. Sadly, not all providers would agree.

Photo credits: Claus Rebler