Impact of the 2008 U.S. Preventative Services Task Force Recommendation on Frequency of Prostate‐Specific Antigen Screening in Older Men

Lee, Shin Yin; Friderici, Jennifer; Stefan, Mihaela; Rothberg, Michael B.

doi:10.1111/jgs.13061

Cited by 17 publications

(9 citation statements)

References 25 publications

(35 reference statements)

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“…However, our findings regarding the unclear impact of guidelines on screening rates contradict several previous reports that attribute changes in cancer screening trends to published guidelines, [46][47][48][49] although the literature is mixed [50][51][52] and the results are difficult to compare due to different study populations, procedure inclusion criteria, and data sources (billing or survey data). Several of these other studies used more granular data to examine screening rates before and after the publication of a specific guideline, which allows for more precise quantification of the guideline's impact than the descriptive analysis across multiple sites emphasized in our report.…”

Section: Discussioncontrasting

confidence: 98%

Medicare Cancer Screening in the Context of Clinical Guidelines

Maroongroge¹,

Yu²

2018

American Journal of Clinical Oncology

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Both the aggressiveness of screening guidelines and screening rates for the Medicare FFS population peaked and then declined from 2000 to 2012. However, guideline publications did not consistently precede utilization trend shifts. Technology adoption, practical and financial concerns, and patient preferences may have also contributed to the observed trends. Further research should be performed on the impact of multiple, conflicting guidelines in cancer screening.

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Section: Discussioncontrasting

confidence: 98%

Medicare Cancer Screening in the Context of Clinical Guidelines

Maroongroge¹,

Yu²

2018

American Journal of Clinical Oncology

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“…Two recent reviews indicated that screening rates have declined, but these reviews synthesized heterogeneous data including self‐reports (which have been shown to be biased), small areas, and different time periods. Two studies that used objective screening measures spanning 2008 to 2012 showed the same pattern as ours, whereas others using shorter time periods or limited areas showed only declining rates . We found no prior studies of change in PSA screening rates in response to guidelines according to race, although two studies found no differential effect of race when examining referral or stage of disease .…”

Section: Discussionsupporting

confidence: 72%

“…Two studies that used objective screening measures spanning 2008 to 2012 showed the same pattern as ours, 43,44 whereas others using shorter time periods or limited areas showed only declining rates. [45][46][47][48][49][50] We found no prior studies of change in PSA screening rates in response to guidelines according to race, although two studies found no differential effect of race when examining referral or stage of disease. 51,52 Our study has the advantage over these prior studies of using consistent measures of PSA testing well before and after evidence change, with a large enough sample to examine heterogeneity of change across subgroups of men and across areas.…”

Section: Discussionmentioning

confidence: 71%

Exnovation of Low Value Care: A Decade of Prostate‐Specific Antigen Screening Practices

Bynum

Passow

Carmichael

et al. 2018

J American Geriatrics Society

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Background Reducing use of low-value services is a priority for improving quality and lowering cost of care. The release of trial evidence in 2009 showing low value for prostate-specific antigen (PSA) screening in asymptomatic men and the convergence of guidelines offers an opportunity to study how clinical practice evolves with mounting consensus about the low value of a service. Objective Examine PSA screening practice change across subgroups of men defined in guidelines and across regions, identifying factors associated with change in screening practices. Design Observational study using serial cross-sections, 2003 to 2013 Setting National fee-for-service Medicare Participants Men age 68 and older eligible for prostate cancer screening Measurements Outcomes are national PSA screening practices among men age 68 and older from 2003–2013 and change in regional screening rates among men age 75 and older. Results The PSA screening rate among men age 68 and over was 17.2% in 2003, 22.3% in 2008, and 18.6% in 2013 (p<.001 for all differences); rates ended slightly lower than rates in 2003 only among men 80 and older. Racial disparities in screening became less pronounced over this period. Among men 75 and older, change in regional screening rates varied widely, with absolute rates growing by 15 per 100 enrollees in some areas and declining by the same amount in others. Areas with high social capital, a measure associated with diffusion of new ideas, were more likely to decline while malpractice intensity and managed care penetration had no impact. Conclusions Studying Medicare enrollees over time, we found little reduction in PSA screening and even increases by race and in some regions. The heterogeneous changes across regions suggest consistent reduction in the use of low-value care may require change strategies that go beyond evidence and guidelines to include monitoring and feedback on performance.

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“…The differing recommendations for prostate cancer screening have created confusion for primary care providers (PCPs). Previous studies reported that these guidelines reduced PSA screening rates in men >75 years , although studies of self‐reported PSA testing and PCP PSA ordering have not .…”

Section: Introductionmentioning

confidence: 99%

Prostate cancer screening practices in a large, integrated health system: 2007–2014

Misra‐Hebert

Klein

et al. 2017

BJU International

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Objectives To assess prostate cancer (PCa) screening practices in primary care since the initial United States Preventive Services Task Force (USPSTF) recommendation against prostate specific antigen (PSA) testing for older men, and to assess primary provider variation associated with PCa screening. Patients and Methods Our study population included 160, 211 men age >= 40 with at least 1 visit in a primary care clinic in any of the study years in a large, integrated health system. We conducted a retrospective cohort study using electronic medical record data from January 2007 through December 2014. Yearly rates of screening PSA testing by primary care provider (PCP), rates of rescreening and rates of prostate biopsies were assessed. Results Annual PSA screening testing declined from 2007 to 2014 in all age groups as did biennial and quadrennial screening. Yearly rates declined for men >= age 70, from 22.8 % to 8.9 %, ages 50–69, from 39.2 % to 20 % and ages 40–49, from 11 % to 4.6 %. Overall rates were lower for African American men vs. non-African American men; for men with a family history of PCa, rates were similar or slightly higher than for those without a family history. PCP variation associated with ordering of PSA did not substantially change following the USPSTF recommendations. While the number of men screened and rates of follow-up PCa screening declined in 2011–2014 compared to 2007–2010, similar rescreening rates were noted for men age 45–75 with initial PSA levels < 1ng/ml or 1–3 ng/ml in both the earlier and later cohorts. For men age > 75 with initial PSA level < 3 ng/ml screened in both cohorts, follow-up screening rates were similar. Rates of prostate biopsy declined for men >=age 70 in 2014 compared to 2007. For men who had PSA screening, rates of first prostate biopsy increased in later years for African American men and men with a family history of PCa. Conclusions PCa screening declined from 2007 to 2014 even in higher risk groups and follow-up screening rates were not related to previous PSA level. However, rates of first prostate biopsy for men who had a PSA were higher for men with increased risk for PCa in later years. Variation in PSA testing was noted among PCPs. Future work should further explore sources of variation in screening practices and implementation of risk-based strategies for PCa screening in primary care.

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Impact of the 2008 U.S. Preventative Services Task Force Recommendation on Frequency of Prostate‐Specific Antigen Screening in Older Men

Abstract: The 2008 recommendation appeared to reduce PSA screening rates in older men in 2009 and 2010; there was a substantial reduction in men aged 75 and older and a more modest reduction in men aged 65 to 74.

Cited by 17 publications

References 25 publications

Medicare Cancer Screening in the Context of Clinical Guidelines

Medicare Cancer Screening in the Context of Clinical Guidelines

Exnovation of Low Value Care: A Decade of Prostate‐Specific Antigen Screening Practices

Prostate cancer screening practices in a large, integrated health system: 2007–2014

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