E. S. Koh1, A. Y. Lee1, L. G. Morris2, J. L. Marti1 1New York Presbyterian Hospital, Weill Cornell Breast Center, Divisions Of Breast And Endocrine Surgery, Department Of Surgery, New York, NY, USA 2Memorial Sloan-Kettering Cancer Center, Department Of Surgery, Head And Neck Service, New York, NY, USA
Introduction:
National societies in the US (US Preventive Services Task Force, American Cancer Society, American Urologic Association) recommend that men engage in shared decision-making with their doctors regarding the decision to start prostate specific antigen (PSA) testing at age 50 or 55. Examining breast cancer screening, we previously found that most (80%) breast cancer centers in the US recommend screening practices that diverge from national guidelines. Here, we examined US cancer center prostate cancer screening recommendations, hypothesizing that some make recommendations differing from clinical practice guidelines.
Methods:
We reviewed the websites of 1119 cancer centers accredited by the Commission on Cancer, of which 64 were National Cancer Institute-designated cancer centers, from January-June 2021 to determine recommendations for men considering PSA prostate cancer screening. Statistical analyses were performed using two-tailed Fisher’s test with α<.05.
Results:
Of 607 cancer centers providing recommendations about prostate screening, 451 (74%) recommended that men have a discussion with their doctor about prostate cancer screening, in accordance with national guidelines that recommend shared decision-making: 209 centers (34%) recommended discussion at age 50 and 106 (17%) at age 55 (Figure). Contrary to guidelines, 156 centers (26%) made universal recommendations for all men to start screening: 22 centers (4%) advised starting before age 50; 114 (19%) at age 50; and 16 (3%) at age 55. Non-NCI centers were more likely than NCI centers to advise shared decision-making (76% vs 54%, P=0.009) and less likely to definitively recommend screening regardless of discussion (24% vs 46%, P=0.009, Figure). While 377 centers (62%) did not discuss the risks of screening, 113 (19%) acknowledged risks without further specification, and 116 (19%) detailed risk(s) of screening.
Conclusion:
Contrary to guidelines that advise men to discuss prostate cancer screening with their doctors, many US cancer centers (26%) recommend that all men undergo screening. While the majority make recommendations that align with national guidelines, most (62%) do not discuss screening risks. These findings are in contrast to US cancer center breast cancer screening recommendations, which we have found diverge from national guidelines in over 80% of cases. These differences between PSA and mammography screening illuminate differences in how cancer centers advise men and women considering screening. Our data also reveal opportunities to encourage shared decision-making for PSA testing–an intervention with both benefits and harms–as an alternative to universal recommendations that may increase overdiagnosis and unnecessary treatment of indolent tumors.
