Study Finds VAMCs Not Following Protocol on Prostate Cancer Screenings

A study in the Journal of General Internal Medicine found that the Department of Veterans Affairs’ medical centers (VAMCs) are screening elderly men with limited life expectancy for prostate cancer at rates that greatly exceed the norm.

The study looked at screenings of over 622,000 men over the age of 70 at 104 VAMCs during 2003.  The researchers found that the national average for men over 85 who were given the prostate-specific antigen (PSA) screening was 45 percent.  In stark contrast, the expected screening rate for this group is zero to 20 percent.  The researchers did not find any VAMCs which screening rate fell within this zero to 20 percent category.

The U.S. Preventive Services Tasks Force recommends that men over the age of 75 should not receive the PSA screening test because the risks outweigh the benefits.  The risks include false positive results and unneeded medical treatments.

However, the researchers found a vast differentiation between the screening rates at individual VAMCS – ranging from 25 percent to 79 percent.  Some of this variation was accounted for by regional differences – as VAMCs in the southern US generally had higher screening rates.  Additionally, medical centers that employed a higher ratio of nurse practitioners and physician’s assistants also were more likely to have a higher screening rate.

Troublingly, the research found that all men were screened at the same rate – regardless of whether they were healthy and had a long life expectancy or ill and had a limited life expectancy.

The researchers state that the decision as to whether an older male receives a PSA screening should be made on an individual basis.

The researchers recommended that new interventions be implemented at VAMCs to lower the number of unnecessary PSA screenings and to educate patients on the risks and benefits of the test.  They noted that one benefit of the national VA medical system is that this system allows for a problem like this to be recognized and resolved.

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