“First, do no harm.” Most of us know that this phrase is the first tenet of medicine. Unfortunately, health providers can inadvertently harm patients while trying to help them. We know that certain tests, procedures, and even advice can unintentionally hurt a patient. We also know, from much research, that more health care doesn’t equal better health.
The draft prostate cancer screening recommendation recently released by the US Preventive Services Task Force (USPSTF) brings this issue to the surface. The USPSTF has recommended that healthy men should not be screened for prostate cancer using the prostate-specific antigen (PSA) screening test. Although relatively inexpensive and painless, the USPSTF’s research found that testing for high PSA levels does not save lives. In fact, many men suffered significant and lasting negative effects (including impotence) from the required follow-up procedures needed to determine if cancer is present. The research also uncovered that men that are diagnosed with prostate cancer usually die from something else because their prostate cancer grew very slowly. Thus, the USPSTF has issued a D recommendation for routine PSA testing in healthy men, meaning that the harms of the test outweigh the benefits. It still encourages shared decision-making between providers and their patients, and emphasizes that this recommendation does not apply to men with symptoms that are highly suspicious for prostate cancer.
Preventing disease is necessary for improving our nation’s health. But not all preventive services are effective. Not all health care, even screening, is beneficial. We must examine the evidence, carefully evaluate the harms versus the benefits, and follow wherever the evidence leads us, even if it means deviating from the norm. As the chair of the USPSTF said, “…evidence — rather than tradition — should drive screening decisions.” Partnership couldn’t agree more.
Jason Spangler, MD, MPH
Chief Medical Officer