Men Resisting Recommendation to Skip PSA Test

In May 2012 the U.S. Preventive Services Task Force (USPSTF) issued a statement advising against prostate-specific antigen (PSA) testing to screen for prostate cancer. In March 2013, Consumer Reports echoed the USPSTF in a cover article that claimed that the benefits of PSA testing did not outweigh its risks.

WIIFMIn the prostate cancer community, these recommendations have been extremely controversial—especially among men whose prostate cancer was discovered through PSA testing.  Most men believe that if they had followed the current USPSTF guidelines, they’d be dead by now.

Others in the medical community have stated that eliminating PSA testing would return us to the pre-PSA era, when prostate cancer was usually diagnosed only after it had reached an advanced or metastatic state and was therefore incurable. In short, assertions on either side of the controversy have been more passionate than substantive.

But now there are actual data demonstrating that men are generally unhappy with the USPSTF recommendation.

An article published in the September 2013 issue of the American Journal of Preventive Medicine reports, “consumers are favorably disposed to PSA testing, despite new evidence suggesting that the harms outweigh the benefits.” The journal wraps up its analysis with the understated conclusion that “the new USPSTF recommendation against PSA testing in all men may be met with resistance.”[1]

A web-based survey of 1,089 men between 40 and 74 years old, all without prostate cancer, was conducted in late 2011, shortly after the USPSTF announcement. Of those surveyed, only 13 percent agreed with the USPSTF recommendation to cease all PSA screening, while 54 percent said they “planned to not follow the U.S. Preventive Services Task Force recommendation and get a prostate-specific antigen test in the future.” The remaining 33 percent said they were undecided.

Running the survey data against various criteria, the authors reported that “black race, higher income, having a PSA test in the past 2 years, and being somewhat/very worried about getting prostate cancer were all positively associated with being a ‘non-intender.'” In other words, more than half the men, including African Americans and those with higher incomes, did not intend to follow the USPSTF recommendation and planned to continue regular PSA testing.

The results of this survey imply that it will take more than a government pronouncement or an article in Consumer Reports to change men’s beliefs about cancer screening.

Marketing professionals like myself know is that people’s attitudes are changed very slowly, generally only after an individual perceives tangible value in what is being marketed. In other words, people change their minds when they can definitely answer the question, “what’s in it for me (WIIFM)?”

Claiming that too many men have been over-diagnosed and over-treated for prostate cancer as the rationale to stop most PSA testing may sound perfectly logical at a statistical public heath level.  But for the individual man who fears that he may someday acquire this all-too-common cancer, telling him not to bother with a simple test violates the rule of WIIFM.

Unless the USPSTF can articulate a positive individual benefit for men to forgo testing beyond scaring them with stories of “biopsies gone bad,” as the Consumer Reports article attempted to do, basic self interest will motivate most men to keep getting their PSA tested.  The public health downside of PSA testing leading to over-diagnosis and overtreatment is simply too abstract.

It will be interesting to see how the government markets this recommendation—or even if it can. Under the terms of the Affordable Care Act (aka “Obamacare”), the USPSTF recommendations could result in Medicare and Medicaid denying payments for PSA testing.  Insurance companies generally follow Medicare’s guidelines for reimbursements. A federal mandate accompanied by financial consequences is not a positive marketing approach to get men to forgo cancer screening.

Unless the USPSTF can figure out how to transform its “skip the test” message into a clear WIIFM, there seems to be little doubt that men’s resistance to forgoing regular PSA testing will continue.

[1] L.B. Squiers, et al., “Prostate-specific antigen testing: Men’s Responses to 2012 Recommendation Against Screening,” Am J Prev Med. 2013 Aug;45(2):182-89.

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