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04-03-2013 | Article

Task force guidelines show impact with notable decline in PSA tests


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medwireNews: Ever since the US Preventive Services Task Force recommended in 2008 that men who are 75 years and older should not be screened for prostate cancer, the demographic has shown an 8 percentage point drop in annual PSA testing over 2 years.

A Health Affairs study regarded the decrease as a display of strength of guidelines that recommend against the use of a low-value medical care, despite four out of 10 men in the age group still getting their PSA levels checked

"There's a lot of skepticism in the medical community that guidelines don't work, especially when the guidelines recommend less care," primary author David Howard (Emory University, Atlanta, Georgia) told Kaiser Health News.

Howard and colleagues from the Centers for Disease Control and Prevention looked at PSA testing rates from 2006-10 in the Medicare Current Beneficiary Survey Access to Care files to compare annual testing rates of Medicare claims pertaining to recipients who were 65-74 years old versus 75 years and older.

Based on 7418 unique respondents who provided 14,926 person-year observations, PSA testing rates were found to be fairly constant between 2006 and 2007 for men aged 75 years and older. These rates began to decline beginning in 2008, giving an ultimate decrease of 5.3 percentage points in PSA testing rates between 2006 and 2010. This was despite the absence of any changes to Medicare's payment policy, which continues to cover PSA tests.

Conversely, testing rates increased by 2.4 percentage points in men aged 65-74 years over the same time period - producing a significant 7.9 percentage-point overall difference in PSA testing rates between the two age groups.

"[A] major change in behavior occurred - and it was accomplished without coercion, regulation, or changes in coverage policies," writes the research team. "Thus, our study highlights the potential of guidelines that include negative recommendations to reduce the use of services that are harmful, unnecessary, or of low value."

Last year, the task force's recommendation against routine PSA screening was expanded to any age who have no symptoms of prostate cancer. This, as well as the 2009 revision to breast cancer screenings, has ignited controversy among clinicians - especially when insurers will be required to cover services recommended by the task force based on the Affordable Care Act.

By Peter Sergo, medwireNews Reporter