Embargoed news from Annals of Internal Medicine

PHILADELPHIA, August 5, 2008 – The U.S. Preventive Services Task Force (USPSTF), updating its 2002 report, now recommends against routine prostate cancer screening for men over the age of 75. More evidence is needed to determine if men under 75 could benefit from screening.

Previously, the Task Force concluded that there was insufficient scientific evidence to recommend screening for all men, and found inconclusive evidence that early detection improves health outcomes. The updated recommendations appear in the August 5, 2008 issue of Annals of Internal Medicine, the American College of Physicians' flagship journal, and are available online at www.annals.org.

Prostate cancer is the most common non-skin cancer and the second leading cause of cancer death in men in the United States, affecting one in six men. Measurement of prostate-specific antigen (PSA) in the blood can detect prostate cancer before symptoms develop. Some abnormal PSA levels may require prostate biopsy to see if cancer is actually present.

While the PSA tests are effective for detecting disease, the Task Force found that there is insufficient evidence that they improve long-term health outcomes.

"We carefully reviewed the available evidence to measure the benefits and harms of screening for prostate cancer and could not find adequate proof that early detection leads to fewer men dying of the disease," said Task Force Chair Ned Calonge, M.D., M.P.H., who is also Chief Medical Officer for the Colorado Department of Public Health and Environment, Denver. "At this point, we recommend that men concerned about prostate cancer talk with their health care providers to make a decision based on their individual risk factors and personal preference."

A National Health and Nutritional Examination Survey (1999 - 2004) of more than 12,000 patients aged 18 to 64 concluded that an estimated 11.4 million americans with chronic medical conditions, such as cardiovascular disease, hypertension, and diabetes, were uninsured. The survey found that chronically ill patients without insurance were less likely than those with coverage to report a physician visit within the last 12 months and more likely to report using an emergency department as a standard site for care. The authors estimated that nearly one-third of unisured U.S. adults had at least one chronic condition. However, authors say that given the limited access to care among those without insurance, undiagnosed conditions in this population may be common. The authors call for advocacy focused on expansion of health insurance coverage, as lack of health insurance is strongly associated with poor access to care.

In 2006, the Centers for Disease Control and Prevention (CDC) recommended that all persons aged 13 to 64 be offered HIV screening in healthcare settings. Rapid HIV tests provide results before a patient leaves the healthcare setting and hold great appeal for screening in settings such as emergency departments. However, information is lacking about how often patients who have a positive rapid test in the emergency department actually have HIV infection confirmed with traditional HIV testing. In the study, 849 adults underwent HIV testing with the rapid test when they visited an emergency department for another reason. Of these, 39 tested positive. However, only 5 of the 39 were shown to actually have HIV infection after traditional testing was done. Twenty-six of 39 were negative and 8 refused traditional testing. This study suggests that many patients who test positive with this rapid HIV test are "false positives," meaning that they do not truly have HIV infection. The authors conclude that quick and more reliable methods of testing are needed.

While urge incontinence, or "overactive bladder," is commonly treated with pharmacotherapy and behavior modification, most patients do not achieve complete continence with either therapy alone. In a trial, 307 women with urge incontinence were randomly assigned to 10 weeks drug therapy plus behavioral training or drug therapy alone. Six months later, 41 percent of women in both groups reported a 70 percent or greater reduction in the frequency of incontinence episodes without additional treatment. However, more women in the combination therapy group reported that they were completely satisfied with their progress than did women in the drug therapy-alone group. According to the authors, the study results suggested that patient satisfaction may be influenced by other features such as volume of urine loss, frequency of voiding, or intensity of the urge sensation.

Annals of Internal Medicine is one of the five most widely cited peer-reviewed medical journals in the world. The journal has been published for 81 years and accepts only 7 percent of the original research studies submitted for publication. Annals of Internal Medicine is published by the American College of Physicians (http://www.acponline.org) (ACP), the largest medical specialty organization and the second-largest physician group in the United States. ACP members include 126,000 internal medicine physicians (internists), related subspecialists, and medical students. Internists specialize in the prevention, detection, and treatment of illness in adults.