After its Recommendation Against - The USPSTF Admits it lacked Evidence for African Americans on PSA Screening

STATEMENT made by USPSTF Chair AFTER its final recommendation against PSA screening:

"To be sure, there are gaps in the existing evidence on this topic. One particular area of concern is that African American men have a higher risk of developing prostate cancer and dying from it. The same is true for those with a family history of the disease. There is no evidence to suggest, however, that these men have an increased benefit from current prostate cancer screening or that the balance of benefit and harms is any different for them. We need more research to improve the health of men at high risk for prostate cancer and to eliminate health disparities."

U.S. Preventive Services Task Force. Prostate Cancer: We Can Do Better: Editorial on Screening for Prostate Cancer from USPSTF Chair Dr. Virginia Moyer. May 2012.

COMMENT by Thomas A. Farrington, PHEN President:

Dr. Moyer's statement admitting that there are "gaps" in the existing evidence for African American men and men with a family history of prostate cancer is quite revealing. This is clearly the answer to why the Task Force did not respond to a request to present such evidence in a public forum by Congressmen Meeks(NY), Cummings(MD) and Towns(NY).

In the absence of evidence the USPSTF does not have the authority to make assumptions and extrapolate data as it has in this instance, either the data exists or it does not. The USPSTF has the responsibility to make recommendations based strictly on existing evidence according to its own set of options (see 1 below). Using these options the USPSTF MUST retain its "I" level recommendation for African Americans and men with a family history. The USPSTF had maintained an "I" recommendation for all PSA screening for men under the age of 75 prior to this recent downgrade based on "new evidence." The downgrade for African and other high risk men in the face of the evidence gaps cited by Dr. Moyer violates the USPSTF's authority. I believe that this violation may constitute a legal issue. Of significance is the fact that insurance coverage was provided for PSA tests with an "I" grade recommendation by the USPSTF.

(1)The USPSTF updated its definitions of the grades it assigns to recommendations and now includes "suggestions for practice" associated with each grade. The USPSTF has also defined levels of certainty regarding net benefit. These definitions apply to USPSTF recommendations voted on after May 2007.

USPSTF Recommendation Grade Levels - Grade Definition Suggestions for Pratice:

A The USPSTF recommends the service. There is high certainty that the net benefit is substantial. Offer or provide this service.

B The USPSTF recommends the service. There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial. Offer or provide this service.

C Note: The following statement is undergoing revision.

Clinicians may provide this service to selected patients depending on individual circumstances. However, for most individuals without signs or symptoms there is likely to be only a small benefit from this service. Offer or provide this service only if other considerations support the offering or providing the service in an individual patient.

D The USPSTF recommends against the service. There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits. Discourage the use of this service.

I The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the service. Evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined. Read the clinical considerations section of USPSTF Recommendation Statement. If the service is offered, patients should understand the uncertainty about the balance of benefits and harms.

Read Dr. Moyer's full editorial:

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