Studies examine recent prostate Ca screening trends

Two new studies shed light on recent trends in prostate cancer screening.

One study found that prostate cancer screening in men older than 74 years of age is overused, while another documented a decline in prostate and other preventive cancer screenings over the last 10 years, possibly due to disagreement over current screening guidelines.

In an analysis of overuse of ambulatory health care services in the U.S., researchers from Mount Sinai School of Medicine, New York reported overuse of prostate cancer screening in older men. First author Minal S. Kale, MD, and colleagues analyzed data from the 1998, 1999, 2008, and 2009 National Ambulatory Medical Care Survey and the outpatient department component of the National Hospital Ambulatory Medical Care Survey.

The authors found a statistically significant improvement in six of nine underuse quality indicators. The authors also observed improvement in two of 11 overuse quality indicators. However, there was an increase in one overuse indicator; namely, prostate cancer screening in men over age 74. The authors observed no changes in the other eight quality indicators during the study period.

"We found an improvement in most of the underuse measures but limited changes in the delivery of inappropriate care. Developing clinical practice guidelines that define when care should not be delivered and performance measures to address inappropriate care are critical steps to advance the mission of increasing the value and efficiency of health care delivery," concluded the authors, who published their findings online in Archives of Internal Medicine (Dec. 24, 2012).

Separately, researchers from the University of Miami Miller School of Medicine found that the rate at which Americans seek preventive cancer screenings, including prostate cancer screening, has fallen over the last 10 years, with wide variations between white-collar and blue-collar workers.

For their National Institutes of Health-funded study, lead author Tainya Clarke, MPH, and colleagues evaluated the cancer screening behaviors of the general public and cancer survivors to see whether government-recommended screenings goals were achieved.

The authors looked at cancer screening adherence rates for prostate, colorectal, breast, and cervical cancers and compared the screening rates among the general public to all cancer survivors and to the subpopulation of employed survivors.

Results showed that the general public did not meet government goals for cancer screenings for any cancer types except colorectal cancer.

By contrast, cancer survivors had higher screening rates and underwent the recommended cancer screenings for all types except cervical cancer. The study also showed a decline among cancer survivors who sought cancer screenings over the last 3 years.

The authors, who published their findings online in Frontiers in Cancer Epidemiology and Prevention (Dec. 27, 2012), used the recommended cancer screening rates set by the U.S. Department of Health and Human Services and looked at data from the National Health Interview Survey between 1997 and 2010. In total, 174,393 people were included in the study analysis, with 7,528 employed cancer survivors and 119,374 people representing the general population.

In addition, the study showed that among survivors, white-collar workers had higher screening rates than blue-collar workers-a discovery that Clarke hopes will help change current job-related policies and overcome disparities within different professions of working cancer survivors.

The authors speculated that ongoing disagreements among the United States Preventive Services Task Force, American Cancer Society, and others over screening guidelines, as well as the decrease in worker insurance rates over the decade, may have influenced the decline in screening rates.