Improve Preventive Task Force Recommendations, Preserve Access to Prostate Cancer Screening

The United States Preventive Services Task Force (USPSTF) plays a critical role in preventive care because its recommendations dictate what preventive services many health plans must provide without cost sharing. Currently, however, the USPSTF has little accountability. Task Force members are appointed by an unelected official and do not meet with relevant stakeholders during their review process. Although recommendations are intended for a primary care audience, they impact patient access to appropriate specialty care. Specialty physicians who treat the conditions that are being screened for play no official role during the development of USPSTF recommendations.

In recent years, the USPSTF has issued controversial ratings on a variety of health care services, including routine breast cancer screening, skin cancer screenings, and dementia screening in older Americans. Urologists were specifically concerned with its 2012 recommendation against prostate-specific antigen (PSA) based screening for prostate cancer for all men, regardless of risk.

On April 11, 2017, however, the USPSTF released an updated draft recommendation statement upgrading the recommendation grade for prostate cancer screening in men ages 55 to 69, thereby recognizing that the decision to screen for prostate cancer should be based on an individualized approached after discussion with a physician about the potential benefits and harms of screening. But while urologists were pleased with the revised recommendation for men ages 55 to 69, they were disappointed in its failure to upgrade its recommendation for men age 70 and over.

Even though the USPSTF recommendation for prostate cancer is evolving, the fundamental issues with the Task Force remain. The USPSTF Transparency and Accountability Act is thus crucial to the urologic community and the health of our patients.

H.R. 3534 would require the Task Force to (1) publish research plans and allow public comment on designated evidence; (2) include medical specialty physicians on the panel; and (3) establish an advisory board tasked with developing, updating, and disseminating evidence-based recommendations. The bill also codifies the USPSTF grading system so it cannot be changed without review and prohibits Medicare or other payors from denying payment for a preventive service solely based on the task force grade. Finally, it prohibits the application of any quality measure related to a USPSTF recommendation unless the grade was developed in accordance with the Act and if the Secretary of Health and Human Services concurs.

Clinical urologists urge all members of Congress to co-sponsor legislation to reform USPSTF processes and support a man’s right to be tested for prostate cancer — and to have his insurance pay for it — if he decides to do so following a detailed conversation with his urologist about the benefits and harms.