Death panels say prostrate cancer not worth detecting?
The US Preventive Services Task Force ruled last week that screening for prostate cancer is a waste of money.
Get ready for many more such outrages: This is the agency that will determine which preventive services ObamaCare will require health plans to cover free of charge.
The task force claims that screening all adult men with the PSA (protein-specific antigen) test doesn’t prevent death from the disease. It argues that “the number of men who avoid dying of prostate cancer because of screening after 10 to 14 years is, at best, very small.”
Adding to the “costs” of the test are “false positives” — they tell people they have cancer when they don’t about 10 percent of the time. The task force thinks this problem makes the cost of screening higher than the tiny benefit screening generates for society.It’s worth analyzing the road to this conclusion, because it tells us a lot about how ObamaCare rations medicine.
First, the task force measures the effect of testing on the death rate from any disease (all-cause mortality). That’s a bogus benchmark, because, as John Maynard Keynes famously noted, in the long run we all die. In fact, death rates from prostate cancer have dropped 57 percent among men ages 49 to 64 and 80 percent among adult men over 75. National Cancer Institute data show that prostate cancers are being detected and treated earlier and that life expectancy is rising as a result.
The task force claims there is no evidence that screening directly reduces prostate cancer. But how, then, did death rates decline, if screening doesn’t work?
It does, of course. As prostate-cancer expert William Catalano notes, PSA screening is why the horror of not diagnosing this cancer until it has metastasized (advanced and spread) has all but disappeared.
The task force states that because the PSA test is imprecise, it will always lead to overdiagnosis. But false positives are a risk of all screening, and the error rate for prostate-cancer screening is no higher than screening for other illnesses or cancers.
Catalano also points out that it’s regular testing — not the test being used — that has likely contributed to raising the odds against the disease.
It should be noted that the death rate from prostrate cancer in the UK, where the folks from NICE dictate what treatment and testing is permitted, is much higher than in the US. I have several friends who have been diagnosed and treated as a result of the PSA testing. I have undergone the testing myself because of a problem with a swollen prostrate. I trust my doctors to make the decision of when testing is appropriate much more than some impersonal panel.The task force also claims that the PSA test can’t tell us which tumors to treat. Yet it gives the patient and his doctors time to figure that out.