Prostate Cancer Screening Guidelines Fall Short
In May 2017, FORCE submitted comments on the U.S. Preventive Services Task Force (USPSTF) Draft Recommendation Statement and Evidence Review for Prostate Cancer Screening. The USPSTF is a panel of experts in prevention and evidence-based medicine that reviews and develops recommendations on the effectiveness of a broad range of preventive services. These guidelines are used by health care providers to determine appropriate screening and preventive care, and to inform insurance coverage decisions on specific preventive services.
The Affordable Care Act stipulates that any preventive service receiving a USPSTF rating of "A" or "B" must be covered by most health plans with no copay or cost-sharing for the patient. Consequently, these guidelines impact access to care for many members of the hereditary cancer community.
Unfortunately, the guidelines now give a grade "C" to the use of prostate-specific antigen (PSA) testing to screen for prostate cancer. This means that the USPSTF recommends "selectively offering or providing this service to individual patients based on professional judgment and patient preferences." The is an improvement as the prior guidelines, published in May 2012, gave a "D" to PSA testing and recommended against its use in early detection of prostate cancer. We are concerned, however, that a grade "C" may negatively affect health care coverage for cancer screening of men with BRCA or other inherited genetic mutations, which predispose them to prostate cancer.
It is important to differentiate between "average risk" men and those who may be at increased risk of cancer. FORCE suggested that the Task Force review the data, extend the evaluation and assign a grade "B" for PSA testing in high-risk men but it failed to do so. The guidelines mention the potential need for increased screening among African American men and those with a family history of prostate cancer. This does not serve the best interests of our community, however, since over half of the men with metastatic prostate cancer, who carry an inherited BRCA or ATM mutation, have no known family history of the disease.
For high-risk men who encounter issues with insurance coverage of prostate cancer screening, we have created a customizable sample appeal letter which makes the case that this screening is medically necessary.
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