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      Use of prostate-specific antigen testing in Medicare beneficiaries: Association with previous evaluation

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          Abstract

          Objective: Determine uptake of prostate-specific antigen (PSA) testing in Medicare beneficiaries according to previous receipt of PSA testing.

          Methods: A 5% random sample of men aged 67 years or older without a previous diagnosis of prostate cancer was identified through 2009–2012 Medicare claims. We measured the annualized frequency of PSA screening among men due for PSA testing, stratified by PSA testing use in the previous 2 years, and clustered by ordering provider.

          Results: Throughout the study period, PSA testing use was consistently higher for men with previous screening than for men without previous screening. For men without previous screening, there was a decline in testing that was most pronounced in 2012. Compared with 2009, the corresponding odds ratios were 0.98 [95% confidence interval (CI) (0.96–1.00)] in 2010, 0.94 [95% CI (0.92–0.95)] in 2011, and 0.66 [95% CI (0.65–0.68)] in 2012. In contrast, for men with previous screening, PSA testing frequency was stable from 2009 to 2011, and declined to a lesser extent in 2012 [odds ratio 0.80, 95% CI (0.79–0.81)].

          Conclusion: Receipt of PSA testing is highly dependent on whether an individual was tested in the recent past. In previously unscreened men, the largest decrease occurred in 2012, which may reflect in part the publication of US Preventive Services Task Force guidelines, but there was much less impact among men already being screened.

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          Most cited references 20

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          Mortality results from a randomized prostate-cancer screening trial.

          The effect of screening with prostate-specific-antigen (PSA) testing and digital rectal examination on the rate of death from prostate cancer is unknown. This is the first report from the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial on prostate-cancer mortality. From 1993 through 2001, we randomly assigned 76,693 men at 10 U.S. study centers to receive either annual screening (38,343 subjects) or usual care as the control (38,350 subjects). Men in the screening group were offered annual PSA testing for 6 years and digital rectal examination for 4 years. The subjects and health care providers received the results and decided on the type of follow-up evaluation. Usual care sometimes included screening, as some organizations have recommended. The numbers of all cancers and deaths and causes of death were ascertained. In the screening group, rates of compliance were 85% for PSA testing and 86% for digital rectal examination. Rates of screening in the control group increased from 40% in the first year to 52% in the sixth year for PSA testing and ranged from 41 to 46% for digital rectal examination. After 7 years of follow-up, the incidence of prostate cancer per 10,000 person-years was 116 (2820 cancers) in the screening group and 95 (2322 cancers) in the control group (rate ratio, 1.22; 95% confidence interval [CI], 1.16 to 1.29). The incidence of death per 10,000 person-years was 2.0 (50 deaths) in the screening group and 1.7 (44 deaths) in the control group (rate ratio, 1.13; 95% CI, 0.75 to 1.70). The data at 10 years were 67% complete and consistent with these overall findings. After 7 to 10 years of follow-up, the rate of death from prostate cancer was very low and did not differ significantly between the two study groups. (ClinicalTrials.gov number, NCT00002540.) 2009 Massachusetts Medical Society
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            Cancer screening in the United States, 2016: A review of current American Cancer Society guidelines and current issues in cancer screening.

            Each year the American Cancer Society (ACS) publishes a summary of its guidelines for early cancer detection, data and trends in cancer screening rates, and select issues related to cancer screening. In this issue of the journal, we summarize current ACS cancer screening guidelines, including the update of the breast cancer screening guideline, discuss quality issues in colorectal cancer screening and new developments in lung cancer screening, and provide the latest data on utilization of cancer screening from the National Health Interview Survey.
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              National Prostate Cancer Screening Rates After the 2012 US Preventive Services Task Force Recommendation Discouraging Prostate-Specific Antigen-Based Screening.

              In 2012, the US Preventive Services Task Force (USPSTF) discouraged prostate-specific antigen (PSA) -based prostate cancer screening. Previous USPSTF recommendations did not appreciably alter prostate cancer screening. Therefore, we designed a trend analysis to determine the population-based impact of the 2012 recommendation.
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                Author and article information

                Journal
                FMCH
                Family Medicine and Community Health
                FMCH
                Compuscript (Ireland )
                2009-8774
                2305-6983
                July 2017
                September 2017
                : 5
                : 2
                : 109-118
                Affiliations
                1Division of Gastroenterology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave., Cleveland, OH 44106, USA
                2Department of Urology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave., Cleveland, OH 44106, USA
                3Case Comprehensive Cancer Center, Wearn Building, Case Western Reserve University, 11100 Euclid Ave., Cleveland, OH 44106, USA
                4Department of Epidemiology and Biostatistics, School of Medicine, Wood Building, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH 44106, USA
                5Department of Health Policy and Management, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave., NW, Washington, DC 20052, USA
                Author notes
                CORRESPONDING AUTHOR: Gregory S. Cooper, Division of Gastroenterology, University Hospitals Cleveland Medical Center, 11100 Euclid Ave., Cleveland, OH 44106, USA, Tel.: +1-216-8445385, Fax: +1-216-9830347, E-mail: gregory.cooper@ 123456uhhospitals.org
                Article
                FMCH.2017.0131
                10.15212/FMCH.2017.0131
                Copyright © 2017 Family Medicine and Community Health

                This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 Unported License (CC BY-NC 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See https://creativecommons.org/licenses/by-nc/4.0/.

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                Self URI (journal page): http://fmch-journal.org/
                Categories
                Original Research

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