The following op-ed was published on June 1st, 2011 in the New York Times’ Room for Debate blog.
Medicare should stop paying for prostate cancer screening in men over the age of 75.
You may be surprised to hear that, especially coming from a primary care doctor. But evidence is mounting that screening for prostate cancer is not only ineffective in older men, but may actually be harmful.
The cornerstone of prostate cancer screening involves measuring the prostate specific antigen, or P.S.A., in the blood. But the test is notoriously inaccurate and cannot differentiate between prostate cancers that are dangerous and ones that aren’t. It’s a crucial distinction, since most American men diagnosed with prostate cancer won’t die from it.
Studies have been inconclusive about whether prostate cancer screening saves lives. What’s more certain are the harmful effects, including impotence and urinary incontinence, caused by unnecessary prostate procedures stemming from false positive P.S.A. tests. The U.S. Preventive Services Task Force updated their prostate cancer screening guidelines in 2008, and after careful deliberation of the evidence, recommended against screening older men.
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But those guidelines continue to be ignored. This past March, the Journal of Clinical Oncology found that nearly a quarter of men aged 85 and older continued to receive P.S.A. screening tests.
Why is this?
One reason is that Medicare pays for annual prostate cancer screening in all men 50 years and older, with no upper age limit.
Another is that drug companies market aggressively, and profit from, the treatments born from prostate cancer screening, whether necessary or not. In fact, Richard J. Ablin, the immunobiologist who discovered P.S.A. in 1970, called P.S.A. screening a “hugely expensive public health disaster.”
Dr. Kenneth Lin, lead author of the U.S. Preventive Services Task Force’s prostate cancer screening guidelines, also blames the news media. In an email to me, he said “news shows invariably feature athletic septuagenarians on the golf range telling reporters that they don’t want some government panel taking their P.S.A. tests away. But most 75-year-old men are in much poorer health, and prostate cancer surgery has no survival benefits in men over age 65, much less 75.
About $3 billion annually is spent on P.S.A. testing alone, with a substantial portion paid for by Medicare. An upper age limit on prostate cancer screening not only would shave those costs, but more important, spare patients from the harms of unneeded prostate procedures.
Kevin Pho, MD, is a practicing, board-certified internal medicine physician and the founder and editor of KevinMD, which he built from scratch in 2004 to give clinicians and patients a place to be heard. Over two decades, it has become one of the most recognizable physician-led publications in health care, drawing more than 7 million annual page views and over 500,000 followers across social media. He still sees patients in primary care in Nashua, New Hampshire, the practice he says keeps the platform honest.
He is the host of The Podcast by KevinMD, a daily, 15-minute show that has surpassed 2,000 episodes and 2.6 million IAB-certified downloads, featuring physicians, patients, caregivers, founders, and health care leaders in conversation about what they actually see and do. He is also a national media commentator and the coauthor of Establishing, Managing, and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices.
An acclaimed keynote speaker, Kevin speaks nationwide to clinicians and non-clinicians on health care, digital media, physician leadership, and burnout. His signature keynote, “Connect and be heard: Make a difference in health care with social media,” traces his social media journey since 2004 and inspires audiences to strengthen the doctor-patient relationship, make their voices heard in health reform, and turn the tide against clinician burnout. He is the founder of Physician Speaking by KevinMD, a physician-run speakers bureau, and is available for speaking opportunities.
Kevin earned his medical degree from Boston University School of Medicine and completed his internal medicine residency at Boston University Medical Center. The New York Times called KevinMD “a highly-coveted publishing place for doctors and patients,” and Forbes called it a “must-read health blog.” He is an inductee of the Healthcare Internet Hall of Fame, a recipient of the American Medical Writers Association McGovern Award, and a New Hampshire Magazine Top Doctor.
