"If you're the one who has a disease, then the chance of getting it is 100%"
This wry but true old observation about how we, as individuals, perceive statistics comes to mind whenever a new recommendation based on studies of thousands of patients is released. Next week, the United States Preventive Services Task Force will officially announce that it does not advise routine use of the prostate specific antigen (PSA) blood test to screen for prostate cancer.
The USPSTF's announcement will be seen by many as an example of medical progress; the use of research to spare men unnecessary testing and treatment with their accompanying side effects and costs. Many men, and their doctors, though, will react with a sense of uneasiness.
Why is it that new recommendations such as the one about PSA make us anxious?
A few thoughts:
Trust is Challenged: Say you have have a heart murmur. You've been taking antibiotics dutifully for decades before each visit to the dentist to prevent a life-threatening heart infection that can be caused when bacteria in the mouth enter the bloodstream during a dental procedure. Then, one day the American Heart Association announces that you don't need to take the antibiotics anymore. You ask yourself how something that was necessary is, overnight, unnecessary. The doctor who prescribed all those antibiotics may wonder the same thing. If the old recommendation is now "wrong," then could the new one also be?
Everybody Knows Someone Who...Everybody knows somebody whose prostate cancer was picked up early by a PSA test. Every doctor has had that "somebody" as a patient. Doctors and patients alike worry that following a new recommendation to omit a test may cause that "somebody's" cancer to be missed. Also, our fear of a cancer diagnosis is such that we naturally focus on the diagnosis itself and not as much on the side effects of treatment or even on whether the treatment prolongs life.
It's Not About the Money (When It's About Me): No one likes to think of himself or herself as a statistic, especially an economic statistic. When it comes to our health and the health of our families, we may not be moved by the argument of millions of dollars saved vs. the one life saved. Each of us thinks that one life is ours, and that no amount of money would be too much to save it--even for a test of questionable value.
So how will I handle the many questions I will be asked in the coming weeks by men who want to have PSA tests against the advice of the USPSTF? The way I've handled so many other announcements of new guidelines over the years regarding mammography, immunizations, estrogen replacement, and many other issues: I'll review the current recommendations, explain that they've evolved and will probably continue to evolve as more information becomes available, and acknowledge the discomfort that changing expectations can cause for patients and doctors alike.
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