United States Preventive Services Task Force Recommendations Research Articles

Comparison of the characteristics of the population eligible for lung cancer screening under 2013 and population newly eligible under 2021 US Preventive Services Task Force recommendations.

In 2021, the United States Preventive Services Task Force (USPSTF) revised their 2013 recommendations for lung cancer screening eligibility by lowering the pack-year history from 30+ to 20+ pack-years and the recommended age from 55 to 50years. Simulation studies suggest that Black persons and females will benefit most from these changes, but it is unclear how the revised USPSTF recommendations will impact geographic, health-related, and other sociodemographic characteristics of those eligible. This cross-sectional study employed data from the 2017-2020 Behavioral Risk Factor Surveillance System surveys from 23 states to compare age, gender, race, marital, sexual orientation, education, employment, comorbidity, vaccination, region, and rurality characteristics of the eligible population according to the original 2013 USPSTF recommendations with the revised 2021 USPSTF recommendations using chi-squared tests. This study compared those originally eligible to those newly eligible using the BRFSS raking-dervived weighting variable. There were 30,190 study participants. The results of this study found that eligibility increased by 62.4% due to the revised recommendations. We found that the recommendation changes increased the proportion of eligible females (50.1% vs 44.1%), Black persons (9.2% vs 6.6%), Hispanic persons (4.4% vs 2.7%), persons aged 55-64 (55.8% vs 52.6%), urban-dwellers(88.3% vs 85.9%), unmarried (3.4% vs 2.5%) and never married (10.4% vs 6.6%) persons, as well as non-retirees (76.5% vs 56.1%) Respondents without comorbidities and COPD also increased. It is estimated that the revision of the lung cancer screening recommendations decreased eligibility disparities in sex, race, ethnicity, marital status, respiratory comorbidities, and vaccination status. Research will be necessary to estimate whether uptake patterns subsequently follow the expanded eligibility patterns.

Utilization of Radical Prostatectomy vs. Radiation Therapy for Gleason Grade Group 5 Prostate Cancer before and after USPSTF Grade D Recommendation against Prostate-Specific Antigen Screening in 2012

The 2012 United States Preventive Services Task Force (USPSTF) Grade D recommendation against prostate-specific antigen (PSA) screening has resulted in a shift to higher-stage prostate cancer (PC) at diagnosis. While incidence of low-risk prostate cancer has declined, more men are diagnosed with high-risk disease, and multimodal treatment is often required. The impact of this epidemiologic shift on practice patterns, specifically radical prostatectomy (RP) versus definitive radiation therapy (RT), for men with localized PC at high risk of recurrence is unknown. Herein, we evaluate the utilization of RP versus RT in the United States for Gleason grade group 5 (GG5) prostate cancer before and after 2012. We identified 34,011 men with localized GG5 PC treated with (1) RP or (2) RT plus androgen deprivation therapy (ADT) between 2004 and 2017 in the National Cancer Database. We excluded those who were clinically node-positive, had metastatic disease, or received chemotherapy or palliative-intent treatment. Chi-square was used to compare the relative use of RP and RT before versus after January 1, 2012, corresponding to the year of USPSTF recommendation against PSA screening. Annual use of RP versus RT from 2004 to 2017 was compared in academic and non-academic centers using Cochran-Armitage test for trend. Joinpoint regression assessed if 2012 was significant for inflection of crude rates of RP. Finally, we modeled the effect of treatment year (i.e., 2012-2017 versus 2004-2011) on use of RP using multivariable logistic regression. Sensitivity analysis tested an interaction term for facility type (i.e., academic versus community). Tests were two-sided with a 0.05 level of significance. Of the eligible men, 10,745 (31.6%) had T3-T4 disease. Between 2004 and 2011, 36.5% (n = 5,483) underwent RP; between 2012 and 2017, 42.3% (n = 8,034) underwent RP (p = .02). Across all centers, use of RP increased from 31% to 41% (p for trend <.001). In academic centers, use of RP increased from 32% to 44% (p for trend <.001); in community centers, use of RP increased from 30% to 39% (p for trend <.001). 2012 was associated with significant inflection for increase in RP use in all centers. On multivariable analysis, there was an increased odds of receiving RP after 2012 (adjusted OR 1.34, 95% CI 1.28-1.40, p<.001). No differential effect by facility type was observed (p = .15). Utilization of RP for GG5 PC has significantly increased in the United States over the past decade, particularly after the USPSTF Grade D recommendation against PSA screening in 2012. It remains unknown whether oncologic or functional outcomes may be compromised in this group of high-risk men, many of whom require post-prostatectomy RT and/or ADT. While historically rare, prospective comparison of RP versus RT+ADT for GG5 PC may be helpful given the evolving epidemiology of localized PC.

Do age-based discontinuation recommendations influence cervical cancer screening rates? Evidence from the United States' Behavioral Risk Factor Surveillance System, 2016 and 2018

The United States Preventive Services Task Force (USPSTF) recommends that women with adequate prior screening and average cervical cancer risk discontinue routine cervical cancer screening after age 65. This study's objective was to estimate how the USPSTF recommendation affects Papanicolaou (Pap) test rates among women at age 66 in the United States. We used nationally representative 2016 and 2018 Behavioral Risk Factor Surveillance System data for women ages 56–76 (n = 226,031) and a regression discontinuity design to estimate changes in annual Pap test rates at age 66. Among women age 66–76, 22.5% reported receiving a Pap test within the past one year. At age 66, annual Pap rates declined by 5.9 percentage points (p.p.) (95% Confidence Interval [CI]: −7.7, −4.1) off a pre-66 rate of 39%. The change varied by race/ethnicity, education, and marital status. Pap rates did not change discretely for non-Hispanic Black women (0.8 p.p.; 95% CI: −5.4, 7.1) but did for women from other racial/ethnic groups. The decline was larger for women who graduated college (−9.0 p.p.; 95% CI: −12.0, −5.9) than for women without a college degree and for women who were never married (−9.4 p.p., 95% CI: −17.3, −1.5) than for women who were married/partnered or divorced/separated. The USPSTF recommendation to discontinue cervical cancer screening after age 65 leads to a sharp decline in Pap test rates at age 66 but disparately affects women based on race, education and marital status. Further study is needed to assess the consequences of these changes.

Breast, cervical, and colorectal cancer screening test use in the US territories of Guam, Puerto Rico, and the US Virgin Islands

BackgroundThe United States Preventive Services Task Force (USPSTF) recommends breast, cervical, and colorectal cancer screening among eligible adults, but information on screening use in the US territories is limited. MethodsTo estimate the proportion of adults up-to-date with breast, cervical, and colorectal cancer screening based on USPSTF recommendations, we analyzed Behavioral Risk Factor Surveillance System data from 2016, 2018, and 2020 for the 50 US states and DC (US) and US territories of Guam and Puerto Rico and from 2016 for the US Virgin Islands. Age-standardized weighted proportions for up-to-date cancer screening were examined overall and by select characteristics for each jurisdiction. ResultsOverall, 67.2% (95% CI: 60.6–73.3) of women aged 50–74 years in the US Virgin Islands, 74.8% (70.9–78.3) in Guam, 83.4% (81.7–84.9) in Puerto Rico, and 78.3% (77.9–78.6) in the US were up-to-date with breast cancer screening. For cervical cancer screening, 71.1% (67.6–74.3) of women aged 21–65 years in Guam, 81.3% (74.6–86.5) in the US Virgin Islands, 83.0% (81.7–84.3) in Puerto Rico, and 84.5% (84.3–84.8) in the US were up-to-date. For colorectal cancer screening, 45.2% (40.0–50.5) of adults aged 50–75 years in the US Virgin Islands, 47.3% (43.6–51.0) in Guam, 61.2% (59.5–62.8) in Puerto Rico, and 69.0% (68.7–69.3) in the US were up-to-date. Adults without health care coverage reported low test use for all three cancers in all jurisdictions. In most jurisdictions, test use was lower among adults with less than a high school degree and an annual household income of < $25,000. ConclusionCancer screening test use varied between the US territories, highlighting the importance of understanding and addressing territory-specific barriers. Test use was lower among groups without health care coverage and with lower income and education levels, suggesting the need for targeted evidence-based interventions.

Critical gaps in knowledge and implementation of recommendations by the US Preventive Services Task Force

IntroductionThe United States Preventive Services Task Force (USPSTF) has issued 31 recommendations applicable to non-pregnant adults. We hypothesized variability in knowledge and implementation of these recommendations among US family medicine resident physicians. MethodsWe performed two electronic surveys: a local survey, and then a nationally-representative, multicenter, survey. We evaluated self-reported knowledge and implementation of USPSTF recommendations related to non-pregnant adults. Results84 family medicine residents from 40 residency programs across 25 states participated. Knowledge and implementation of recommendations varied widely. Most residents lacked knowledge relating to breast cancer chemoprophylaxis (9.9 % “known in detail” or “mostly know”), BRCA-related genetic counseling (BRCA-GC) referral (30 %), tuberculosis (TB) screening (41 %), and sexually transmitted infection (STI) counseling (45 %). There is virtually no implementation of recommendations for breast cancer chemoprophylaxis (90 % never/rarely implement). Many residents never/rarely implement recommendations for BRCA-GC referral (75 %), TB screening (62 %), and HIV pre-exposure prophylaxis (61 %). This remained true even for residents in their final year of training. Relative to their male counterparts, female physicians more frequently implemented recommendations for BRCA-GC referral (11 % vs 0 % always/often implement, p = 0.019), cervical cancer screening (100 % vs 83 %, p = 0.019), and folic acid supplementation (60 % vs 29 %, p = 0.007). Knowledge and implementation of recommendations were strongly related (β = 0.75, 95 % CI 0.50–1.00, p < 0.001, Spearman R2 = 0.56). ConclusionCritical gaps exist in resident knowledge and implementation of USPSTF recommendations. We discuss urgent implications for cancer prevention, public health, and health equity.

Improving lung cancer screening rates among patients with head and neck cancer in a radiation oncology clinic.

The United States Preventive Services Task Force (USPSTF) recommends lung cancer screening via annual low dose computed tomography (LDCT) for high risk patients. Despite the strong evidence of a mortality benefit from several randomized clinical trials, rates of lung cancer screening remain low. We plan to assess how screening guidelines are implemented in a radiation oncology clinic for patients with head and neck cancer. A single institution, retrospective chart review was used to identify patients with head and neck cancer seen in a radiation oncology clinic who were potentially eligible for lung cancer screening under the current USPSTF guidelines. Patients who were potentially screening-eligible were enrolled in a phone survey to assess their knowledge about lung cancer screening and willingness to be screened. Of the 184 patients with head and neck cancer seen in the clinic, 8 (4%) patients were eligible for lung cancer screening under the previous USPSTF recommendations, including 1 (0.5%) patient already being screened. One patient (0.5%) became eligible under the expanded guidelines. All 184 patients had smoking history documented. Of the 87 current or former smokers, there were 24 (28%) who did not have pack-years documented; of the 82 former smokers, there were 8 (10%) who did not have quit date documented. Among the 16 phone survey participants (response rate: 70%) only 6 (38%) were aware there is a way to screen for lung cancer and 12 (75%) patients would be interested in screening if they are found to be eligible. These findings highlight a potential opportunity to increase rates of lung cancer screening among patients with head and neck cancer by both enhancing provider awareness as well as patient education at the community level.

Uptake of USPSTF recommendation to refer pregnant individuals for therapy or counseling to prevent perinatal depression.

Perinatal depression is the most common complication of pregnancy and childbirth, and it is associated with adverse consequences. The United States Preventive Services Task Force (USPSTF) recommends that pregnant and postpartum (i.e., perinatal) individuals at risk for depression be referred for therapy or counseling interventions; however, it is unclear to what extent this recommendation has been implemented. Pregnant individuals were recruited via advertisements on a pregnancy app and a separate study on sleep. Respondents completed the initial screening questions to determine their risk for perinatal depression, defined as self-reported history of depression; recent stressors; history of emotional, sexual, or physical abuse; mild depressive symptoms; anxiety symptoms; single; diabetes diagnosis; or unwanted pregnancy. Eligible respondents reported their providers' recommendations for preventing depression, and their utilization of interventions to prevent depression (n = 303). Fewer than 15% of participants reported that a provider referred them for therapy or counseling to prevent depression; recommendations included cognitive behavioral therapy (4%), interpersonal psychotherapy (2.3%), mindfulness-based cognitive therapy (4.3%), or other/unknown (6.6%). Approximately 12% reported that a provider recommended medication to prevent depression. Provider referral rates varied by risk factor, but not by patient demographics. Nearly 20% of participants reported using therapy or counseling to prevent depression, and nearly 13% reported using medication to prevent depression. We explore potential factors affecting the uptake of the USPSTF recommendation and underscore the importance of preventing perinatal depression.

Exploring the Acceptability of Expanded Perinatal Depression Care Practices Among Women Veterans

BackgroundVeterans receive obstetrical care from community-based providers contracted through the Veterans Health Administration (VA); however, Veterans remain eligible for VA mental healthcare in the perinatal period. To date, few studies have focused specifically on the mental health needs of Veterans during the perinatal period.ObjectiveTo examine the acceptability of more comprehensive perinatal mental healthcare screening and treatment in VA care, we explored pregnant and postpartum Veteran perspectives of United States Preventive Services Task Force (USPSTF) recommendations that aim to expand mental health counseling for the prevention and treatment of perinatal depression.DesignSemi-structured interviews with pregnant and postpartum Veterans enrolled in VA care, integrated with quantitative survey data.ParticipantsPregnant and postpartum Veterans (n=27) who had delivered infants or were due by February 2020.ApproachFramework analysis with an inductive approach was utilized to understand our data, interpret and code our transcripts, and develop themes.Key ResultsFewer than half (44%) of the women reported seeing a mental health provider at the beginning of their pregnancy. We found that Veterans support USPSTF recommendations in the VA, consider mental healthcare to be very important during the perinatal period, would like better access to mental healthcare resources and peer support networks, and suggest that perinatal depression screening could be more extensive.ConclusionsThese findings support the implementation of more comprehensive perinatal depression prevention policies and practices within VA care. Understanding the real-world feasibility and prevailing barriers to comprehensive perinatal depression care is needed to inform implementation of the USPSTF recommendations or a similar intervention tailored for VA care.

Comparing eligibility for statin therapy for primary prevention under 2022 USPSTF recommendations and the 2018 AHA/ACC/ multi-society guideline recommendations: From National Health and Nutrition Examination Survey

IntroductionThe United States Preventive Services Taskforce (USPSTF) recently released recommendations for statin therapy eligibility for the primary prevention of cardiovascular disease (CVD). We report the proportion and the absolute number of US adults who would be eligible for statin therapy under these recommendations and compare them with the previously published 2018 American Heart Association (AHA)/ American College of Cardiology (ACC)/ Multisociety (MS) Cholesterol guidelines. MethodsWe used data from the National Health and Nutrition Examination Survey (NHANES) 2017–2020 of adults aged 40–75 years without prevalent self-reported atherosclerotic CVD (ASCVD) and low-density lipoprotein-cholesterol <190 mg/dL. The 2022 USPSTF recommends statin therapy for primary prevention in those with a 10-year ASCVD risk of ≥10% and ≥ 1 CVD risk factor (diabetes mellitus, dyslipidemia, hypertension, or smoking). The 2018 AHA/ ACC/ MS Cholesterol guideline recommends considering statin therapy for primary prevention for those with diabetes mellitus, or 10-year ASCVD risk ≥20% or 10-year ASCVD risk 7.5 to <20% after accounting for risk-enhancers and shared decision making. Survey recommended weights were used to project these proportions to national estimates. ResultsAmong 1799 participants eligible for this study, the weighted mean age was 56.0 ± 0.5 years, with 53.0% women (95% confidence interval [CI] 49.7, 56.3), and 10.6% self-reported NH Black individuals (95% CI 7.7, 14.3). The weighted mean 10-year ASCVD risk was 9.6 ± 0.3%. The 2022 USPSTF recommendations and the 2018 AHA/ ACC/ MS Cholesterol guidelines indicated eligibility for statin therapy in 31.8% (95% CI 28.6, 35.1) and 46.8% (95% CI 43.0, 50.5) adults, respectively. These represent 33.7 million (95% CI 30.4, 37.2) and 49.7 million (95% CI 45.7, 53.7) adults, respectively. For those with diabetes mellitus, 2022 USPSTF recommended statin therapy in 63.0% (95% CI 52.1, 72.7) adults as compared with all adults with diabetes aged 40–75 years under the 2018 AHA/ ACC/ MS Cholesterol guidelines. ConclusionIn this analysis of the nationally representative US population from 2017 to 2020, approximately 15% (~16.0 million) fewer adults were eligible for statin therapy for primary prevention under the 2022 USPSTF recommendations as compared to the 2018 AHA/ ACC/ MS Cholesterol guideline.

Addressing eating disorders in primary care: Understanding screening recommendations and opportunities to improve care.

For the first time in its history, the United States Preventive Services Task Force (USPSTF) published a recommendation on screening for eating disorders among adolescents and adults in primary care. The current manuscript provides an overview of the USPSTF recommendation, screening principles, and suggestions for clinical and research efforts. The USPSTF based their recommendations on a rigorous systematic review of the evidence on routine screening for eating disorders. Eligible studies included studies of screening test accuracy and controlled trials of screening or interventions for eating disorders in screen-detected or previously untreated eating disorders. The current manuscript briefly summarizes the results of this evidence review which are published in full elsewhere and focuses on providing interpretation of the recommendations by clarifying the scope and methodology of the USPSTF. Fifty-seven studies were included in the evidence review. Seventeen studies evaluated screening test accuracy and 40 trials evaluated interventions among populations with previously untreated eating disorders. No studies directly assessed the benefits and harms of screening. The evidence review highlights important gaps in our knowledge regarding eating disorders in primary care. The authors provide recommendations for future studies in light of these evidence gaps and propose specific clinical strategies to improve care for those with eating disorders who present to primary care. Primary care can play an important role in the early detection of eating disorders, but data are needed to more fully understand the potential benefits and harms of routine screening in this setting. There are gaps in the evidence regarding the benefits and harms of eating disorder screening in primary care. Future studies are needed to improve certainty about the net benefit of screening. Of particular importance are studies that compare routine screening to usual care (no screening). Current providers may benefit from tailored eating disorders education and training, practical tools, and integration of mental health services in primary care.

Primary care providers' and nurses' knowledge, attitudes, and skills regarding latent TB infection testing and treatment: A qualitative study from Rhode Island.

Untreated latent tuberculosis infection (LTBI) is a major source of active tuberculosis disease in the United States. In 2016, the United States Preventive Services Task Force (USPSTF) recommended that screening for latent tuberculosis infection among individuals at increased risk be performed as routine preventive care. Traditionally, LTBI management-including both testing and treatment-has been conducted by specialists in the United States. It is believed that knowledge gaps among primary care team members and discomfort with LTBI treatment are significant barriers to LTBI management being conducted in primary care. This qualitative study sought to evaluate the knowledge, attitudes, and skills of primary care team members regarding the LTBI care cascade, and to identify each stepwise barrier limiting primary care teams in following the USPSTF recommendations. We conducted 24 key informant interviews with primary care providers and nurses in Rhode Island. Our results demonstrate that overall, few primary care providers and nurses felt comfortable with LTBI management, and their confidence and comfort decreased throughout the cascade. Participants felt least confident with LTBI treatment and held misconceptions about LTBI testing, such as high cost. Although participants were not confident about LTBI treatment, most were enthusiastic about treating patients if provided additional training. Participants suggested that their lack of knowledge regarding LTBI treatment led to high rates of referral to specialist providers. The gaps revealed in this study can inform training curricula for primary care team members in Rhode Island and nationally to shift the USPSTF policy into practice, and, ultimately, contribute to TB elimination in the United States.

Rates and trends in stage-specific prostate cancer incidence by age and race/ethnicity, 2000-2017.

The 2008 and 2012 United States Preventive Services Task Force (USPSTF) recommendations against prostate-specific antigen (PSA) screening have led to changes in the incidence pattern of prostate cancer. We sought to examine rates and trends in stage-specific prostate cancer incidence by age and race/ethnicity using the most recent data obtained from Surveillance, Epidemiology, and End Results (SEER) program. SEER*Stat version 8.3.6 was used to analyze annual prostate cancer incidence rates between 2000 and 2017 according to the SEER summary stage, age group, and race/ethnicity group. Incidence rates per 100,000 men were calculated and age-adjusted to 2000 US standard population. Annual percentage change (APC) was performed to identify the trend in prostate cancer incidence. Between 2008 and 2012, trends in incidence of overall and localized prostate cancer significantly declined in comparison with between 2000 and 2007 (APC, -5.4 and -6.0, respectively). However, there was an increase in the incidence rate of both overall and localized prostate cancer from 2014 to 2017 (43.3-46 and 34-34.9 per 100,000 men, respectively). The incidence of regional prostate cancer significantly increased between 2013 and 2017 (5.9-6.8 per 100,000 men; APC, 4.3). Distant disease incidence increased continually between 2008 and 2012 (2.9-3.3 per 100,000 men; APC, 2.3) and between 2013 and 2017 (3.4-4.3 per 100,000 men; APC, 6.0). In addition, these increases in incidence occurred in men of all stratified age and race/ethnicity groups, except for men aged <50 years and American Indian/Alaska Native men. This study demonstrates that the longer-term effects of USPSTF recommendations against PSA screening may have resulted in a reversal of downtrend in prostate cancer incidence, as incidence rates of overall and localized prostate cancer gradually increased from 2014 to 2017. Meanwhile, the trend in stage migration toward advanced disease increased incrementally.

The Use of FRAX in Identifying Women Less Than 65 Years Needing Bone Mineral Density Testing

The purpose of this study is to determine if the United States Preventive Services Task Force (USPSTF) screening guideline for osteoporosis identifies women under the age of 65 with osteoporosis needing bone mineral density (BMD) testing. If the Fracture Risk Assessment Tool (FRAX) tool fails to identify women under the age of 65 with undiagnosed osteoporosis, then diagnosis and treatment are delayed, potentially leading to increased fractures and morbidity. Another aim of this study is to characterize women under the age of 65 with osteoporosis that FRAX fails to identify and provide descriptive data on our study population. A retrospective chart review was completed between 2012 and 2018. We extracted data for 113 women ≤ 65-years with osteoporosis confirmed by BMD or fractures. Major osteoporotic fracture (MOF) risk calculation without BMD by FRAX of 9.3% or greater (high risk group) was found in 51 (45.1%) of patients. Osteoporosis by T-score < 2.5 was evident in 102 (90%) of patients. Previous osteoporotic fractures were noted in 29 (25.7%) of patients. The average age of women in the high-risk group was 58 years and 55 years in the low-risk group. The sensitivity of FRAX for identifying women with a T-score <−2.5 was 40%. The sensitivity of FRAX for identifying women with a history of fracture was 32%. The sensitivity of FRAX for identifying women with a T-score <−2.5 or identifying women with a history of fracture was 32%. These results demonstrate that the FRAX tool alone (USPSTF recommendation) fails to identify many women under the age of 65 with osteoporosis in need of BMD testing. Over half of women would not have had a BMD performed based on guidelines for screening BMD in women <65. Further study is needed to characterize women under the age of 65 with osteoporosis with a FRAX MOF risk less than 9.3%.

MP02-18 MALPRACTICE TRENDS IN THE SETTING OF PROSTATE CANCER SCREENING

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Practice Patterns, Quality of Life and Shared Decision Making I (MP02)1 Apr 2020MP02-18 MALPRACTICE TRENDS IN THE SETTING OF PROSTATE CANCER SCREENING Peter Sunaryo*, Gregory Mullen, Christine W Liaw, Eric Bortnick, and Jay Motola Peter Sunaryo*Peter Sunaryo* More articles by this author , Gregory MullenGregory Mullen More articles by this author , Christine W LiawChristine W Liaw More articles by this author , Eric BortnickEric Bortnick More articles by this author , and Jay MotolaJay Motola More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000816.018AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Medical malpractice (MP) is an important issue in our country. There has been controversy surrounding PSA testing and prostate cancer screening, specifically the United States Preventive Services Task Force (USPSTF) whose 2012 guidelines advised against PSA testing and were modified in 2018. The purpose of this study is to identify factors leading to litigation and recent trends related to the screening of prostate cancer. METHODS: The Westlaw database was used to search for jury verdicts ranging from January 2000 to December 2018. Each case was examined for year of trial, patient age, specialty of defendant, alleged cause of MP, and the case outcome. RESULTS: Of 129 examined cases, 66% went to trial and of those, 69% were decided for the defendant. The mean settlement was $967,000 (K) while the mean verdict was $2.0 million (M). Primary care physicians (PCP) (73.7%) were the most cited defendants followed by urologists (U) (21.2%). There were no significant differences (NSD) between the mean verdict or settlement amount between U and PCP ($1.1M vs. $2.2 M, p = 0.23; $803K vs. $1.0M, p =0.47). The most common cause was failure to follow up for an elevated PSA (37%), followed by failing to get an initial PSA (31%). Lack of follow up for an elevated PSA led to significantly higher settlements when compared to failing to get an initial PSA, but verdicts were NSD ($1.0 M vs. $240K, p = 0.007; $1.8 M vs. $970K, p = 0.12). There was NSD between the mean amount of MP cases per year before and after the USPSTF recommendations (7.9 vs. 4.3, p = 0.03) as well as the mean settlement and mean plaintiff award ($970k vs. $970k, p =0.99; $2.1 M vs. $2.6 M, p = 0.44 respectively). CONCLUSIONS: PSA testing is commonly cited in MP. There were no significant changes seen in the incidence of MP. This may be due to lag time from the time of filing a MP claim until its resolution. Limitations on testing may have future consequences and need to be monitored. Both PCP and U must continue to educate patients in order to minimize malpractice claims made in this setting. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e19-e19 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Peter Sunaryo* More articles by this author Gregory Mullen More articles by this author Christine W Liaw More articles by this author Eric Bortnick More articles by this author Jay Motola More articles by this author Expand All Advertisement PDF downloadLoading ...

Evidence of Stage Migration to Higher Risk Prostate Cancer and its Financial Implications in a Single Institution

The association between the United States Preventive Services Task Force (USPSTF) recommendations limiting PSA screening in 2012 and the subsequent increased detection of higher risk prostate cancer has been characterized in cancer registries. We investigated whether this phenomenon of stage migration could be measured in a high volume department and examine its impact on the cost of treatment. We analyzed an IRB approved database of patients with newly diagnosed prostate cancer treated at our institution from 2006-2018. Patients were stratified according to NCCN Risk groups (Low, Intermediate, and High), as well as by the modified Zumsteg/Zelefsky classification including Favorable and Unfavorable Intermediate risk disease. The frequency of risk group change across time was investigated. Differences in proportions were tested using the Pearson chi-square test. Treatment costs of radiation and androgen deprivation therapy were also obtained at our institution for risk groups. Between 2006 and 2018, 3447 consecutive patients with clinically localized prostate cancer were treated in our practice. The overall risk distribution of treated patients was 31% Low risk, 51% Intermediate risk, and 18% High risk. Further characterization of the Intermediate grouping revealed 25% for Favorable Intermediate risk and 25% for Unfavorable Intermediate risk by Zumsteg/Zelefsky criteria. The distribution of Low risk patients decreased from 48% to 23% in years 2006-2011 compared with 2012-2018; there was a corresponding increase in the High risk cohort from 14% to 19% (p<.0001). Further stratification demonstrated a decrease in patients treated with Low or Favorable Intermediate risk disease (69% vs. 47%) in years 2006-2011 compared with 2012-2018 with a significant increase in those treated with Unfavorable Intermediate or High risk disease (31% vs. 53%, p<.0001). The added cost to our institution due to stage migration was $5,593,500 in 2017. Despite a decreasing incidence of newly diagnosed prostate cancer cases occurring nationally, we have seen an increased percentage of aggressive prostate cancer at our practice over time. Stratified before and after the 2012 release of the USPSTF recommendation to cease PSA screening, this data validates registry series showing an associated stage migration towards more aggressive variants. Over 50% of patients treated in our department now have Unfavorable Intermediate or High risk disease, with only 23% harboring Low risk prostate cancer adding significant cost to treatment. As higher risk subtypes have poorer disease free outcomes compared to lower risk disease, the long-term effects on biochemical control, metastatic-free disease states, and prostate cancer specific survival will need to be assessed over time. While a strong correlation with the 2012 USPSTF recommendation is statistically compelling, competing factors which could also explain these findings should continue to be explored.

Trend analysis in hepatitis C testing, OptumLabs® Data Warehouse, 2011–2017

ObjectiveUsing administrative claims for privately insured and Medicare Advantage enrollees from a large, private, U.S. health plan, we estimated the prevalence of hepatitis C testing among individuals who were recommended to be tested (i.e., baby boomer cohort born between 1945 and 1965) by the CDC and United States Preventive Services Task Force. This panel will discuss strengths and weaknesses for monitoring hepatitis C testing using alternative data sources including self-reported data, insurance claims data, and laboratory testing data.IntroductionHepatitis C virus (HCV) infection is the most common blood-borne disease in the US and the leading cause of liver-related morbidity and mortality. Approximately 3.5 million individuals in the US were estimated to be living with HCV in 2010 and approximately half of them were unaware that they were currently infected. Among HCV infected individuals, those born between 1945 and 1965 (usually referred to as the baby boomer cohort) represents approximately 75% of current cases. Because of the substantial burden of disease among this age group, CDC expanded its existing HCV risk-based testing recommendations to include a one-time HCV antibody test for all persons born between 1945-1965. The United States Preventive Services Task Force (USPSTF) subsequently made the same recommendation in June 2013.MethodsWe obtained health plan enrollment information and claims data from the 2011 - 2017 OptumLabs® Data Warehouse, and utilized data from patients enrolled in either commercially insured programs or Medicare Advantage. We examined trends in HCV testing for the birth cohort born between 1945 and 1965 and compared their trend in testing to individuals who were not in the birth cohort. We developed two different estimates for HCV testing incidence in order to make comparisons to other commercial claims datasets. The denominator for both estimates was the number of adults continuously enrolled in one or more health plan(s) in a given calendar year (allowing up to a 45-day gap in coverage). The numerator for the first estimate was the number of people receiving any HCV related test in the current calendar year who had not received any HCV related test including HCV antibody test, HCV RNA test or HCV genotype test in the previous calendar years. The numerator for the second estimate was the number of people who were given an HCV antibody test (CPT: 86803 and 80074) in a given calendar year, irrespective of previous testing history.ResultsDuring the study period 2011 - 2017, there were 20,332,848 unique adults who met the inclusion criteria in the OptumLabs® data. Approximately 7.1 million (35.0%) of these individuals were born between 1945 and 1965. On average, there were approximately 2.8 million birth cohort enrollees for any given calendar year. For the birth cohort, the annual incidence of HCV testing was about 2% per year during the time period between 2008 and 2011 (data not shown). In general, between 2011 and 2017, the trends in testing rates were consistent across both estimation methods. Specifically for the birth cohort, the HCV testing rate increased substantially between 2012 and 2017, peaking in 2017 at 8.56% [95% CI: 8.53-8.59%] and 10.24% [95% CI: 10.21-10.27%]. The greatest increase occurred between 2016 and 2017 when the testing rate almost doubled. In contrast, for the non-birth cohort, the HCV testing rate started in 2012 at a rate similar to the birth cohort but did not increase in a similar fashion and did not see a substantial increase in HCV testing in 2016 or 2017.ConclusionsSince CDC and USPSTF recommended universal testing for the birth cohort in 2012 and 2013, respectively, hepatitis C testing rates have been increasing across all age groups. The rate of increase for the birth cohort was substantially greater than that for the non-birth cohort. CDC and USPSTF recommendations are likely a strong contributing factor impacting hepatitis C testing rates in the US. Efforts to promote hepatitis C testing should continue.

Hepatitis C testing trends among large commercially insured populations, 2011–2017

ObjectiveWe estimated the rate of hepatitis C testing between 2011 and 2017 among persons with commercial health insurance coverage and compared rates by birth cohort.IntroductionHepatitis C virus (HCV) infection is the most common blood-borne infection in the US, and a leading cause of liver-related morbidity and mortality. Approximately 3.5 million individuals in the US were estimated to have been living with hepatitis C in 2010, and approximately half of them were unaware that they were infected. Among HCV infected individuals, those born between 1945 and 1965 (usually referred to as the baby boomer cohort) represent approximately 75% of current cases. Because of the substantial burden of disease among this age group, CDC expanded its existing hepatitis C risk-based testing recommendations to include a one-time HCV antibody test for all persons born between 1945 and 1965. The United States Preventive Services Task Force (USPSTF) subsequently made the same recommendation in June 2013.DescriptionWe obtained data from the 2011–2017 IBM MarketScan® Commercial Claims and Encounters and Medicare Supplemental and Coordination of Benefits databases. These data consist of inpatient and outpatient service claims for persons with employer-sponsored health insurance coverage and their dependents. This analysis was restricted to adults 18 years of age and older with continuous enrollment in a commercial or Medicare Supplemental plan for at least one calendar year during the study period (a 45-day gap in coverage was allowed) who received outpatient prescription drug claims data feeds. Claims for hepatitis C antibody testing were identified using Current Procedural Terminology (CPT) codes (80074, 86803). We defined the annual hepatitis C testing rate as the number of patients with an HCV antibody test claim divided by the total number of study-eligible enrollees in a given calendar year. Testing rates were calculated for persons born between 1945 and 1965 and all other adults.There were 54,298,561 unique adults who were continuously enrolled for at least one calendar year during the study period. Among these, 4,629,040 (9%) had one or more inpatient or outpatient service claim with a CPT code for hepatitis C antibody testing during the study period. The overall estimated annual testing rate increased from 2.2% in 2011 to 5.3% in 2017. The testing rate increased from 1.7% to 7.8% among the 1945–1965 birth cohort and 2.5% to 4.0% in other birth cohorts. The average annual percent change in testing was 30.1% among the 1945–1965 birth cohort and 8.2% among other birth cohorts. Testing rate increased markedly (64.1%) between 2016 and 2017 in the 1945–1965 birth cohort, but not in other birth cohorts (7.7%).In this sample of individuals covered by commercial insurance, hepatitis C testing rates have increased slowly between 2011 and 2016. In 2017, there was a substantial increase in testing rates among the Baby Boomer cohort due most likely to an increase in awareness of CDC and USPSTF recommendations by both providers and individual patients associated with CDC health promotion efforts and increased marketing efforts by drug manufacturers. Efforts should continue to promote and increase the awareness of these recommendations and have people tested and treated for HCV.How the Moderator Intends to Engage the Audience in Discussions on the TopicThis panel will discuss strengths and weaknesses for monitoring hepatitis C testing using alternative data sources including self-reported data, insurance claims data, and laboratory testing data.

Prevalence of Hepatitis C Testing Among Non-Institutionalized Individuals in the US, NHIS 2013-2017

ObjectiveUsing a large nationally representative dataset, we estimated the prevalence of self-reported hepatitis C testing among individuals who were recommended to be tested (i.e., baby boomer cohort born between 1945 and 1965) by the CDC and United States Preventive Services Task Force.IntroductionHepatitis C virus (HCV) infection is the most common blood-borne disease in the US and the leading cause of liver-related morbidity and mortality. Approximately 3.5 million individuals in the US were estimated to have been living with hepatitis C in 2010 and approximately half of them were unaware that they were infected. Among HCV infected individuals, those born between 1945 and 1965 (usually referred to as the baby boomer cohort) represents approximately 75% of current cases. Because of the substantial burden of disease among this age group, CDC expanded its existing hepatitis C risk-based testing recommendations to include a one-time HCV antibody test for all persons born between 1945 and 1965. The United States Preventive Services Task Force (USPSTF) subsequently made the same recommendation in June 2013.DescriptionMethodsThe following question "Have you ever had a blood test for hepatitis C?" has been administered annually from 2013 through 2017 on the National Health Interview Survey (NHIS). The NHIS is a nationally representative cross-sectional face-to-face household interview of civilian noninstitutionalized individuals in the U.S. The NHIS survey uses a complex multistage probability design that includes stratification, clustering, and oversampling. We estimated the prevalence of hepatitis C testing for adults in the US during the study period from 2013 to 2017. In addition, we carried out stratified analyses comparing those with private insurance to those who did not have private insurance. We reported weighted estimates taking into account the NHIS survey design. The R statistical software (R Core Team, 2018) was used to estimate weighted prevalence estimates for hepatitis C testing.ResultsDuring the study period from 2013-2017, there were 148,674 adults who responded to the ever tested for hepatitis C question. In addition, 33.56% of these individuals were born between 1945 and 1965; among all adults, the weighted percentage of individuals that responded yes they had received a hepatitis C screening test was 12.82% (95% CI: 12.54-13.10%) while for baby boomers the estimate was 13.93% (95% CI: 13.51-14.35%).Figure 1 presents the annual trend in the hepatitis C test prevalence over the study period by birth cohorts. For both cohorts, there were significant increases over time in hepatitis C testing prevalence. The two trend lines began to diverge in 2015 with the baby boomer cohort reporting higher rates of hepatitis C testing. For the baby boomer cohort, there was also a substantial increase in reported hepatitis C testing in 2017 relative to 2016. Similar trends were found for the samples when we restricted the sample to only those with private insurance. Compared to the people with private insurance, the baby boomers with 'Non-private’ insurance, including Medicaid, Medicare, or military- government sponsored insurances, reported higher rates of testing.ConclusionAcross the five-year period from 2013 through 2017, we found increasing rates of self-reported hepatitis C testing among non-institutionalized U.S. adults. For the baby boomer cohort, we saw a substantial increase in testing in 2017, which was likely due in part, to increased awareness among both physicians and patients of the CDC and USPSTF recommendation to have all baby boomers tested. Efforts to increase the awareness of these recommendations should continue. Additional targeted promotions among hard to reach populations should also be considered.How the Moderator Intends to Engage the Audience in Discussions on the TopicThis panel will discuss strengths and weaknesses for monitoring hepatitis C testing using alternative data sources including self-reported data, insurance claims data, and laboratory testing data.

Implications of the United States Preventive Services Task Force (USPSTF) recommendations on prostate cancer (PCa) stage migration.

5071 Background: Prostate specific antigen (PSA) screening has been controversial, given unrefined screening guidelines leading to overdiagnosis and overtreatment of “indolent” PCa. In 2008, the USPSTF recommended against PSA screening for men aged ≥75 and in 2012 broadened this recommendation to include all men. The impact of these changes is unstudied. We hypothesize that these screening changes could delay the diagnosis of advanced PCa. Methods: The Surveillance, Epidemiology and End Results Program (SEER) was used to identify men (age 55-69) diagnosed with PCa between 2004-2015. PCa stage was categorized as nodal (N1M0) and metastatic (NxM1). Trend analysis was stratified based on year 2004-2008 (group 1), 2009-2012 (group 2), and 2012-2015 (group 3). Using group 2 as a reference, multivariable logistic regression was used to identify predictors for N1M0 and NxM1 in each group. Results: From 2004-2015, there were 603,323 eligible men diagnosed with PCa (group 1: 262,240 men, group 2: 210,045 men, group 3: 131,038 men). In group 1, 1.4% had N1M0 and 2.8% had NxM1. In group 2, 1.6% had N1M0 and 3.7% had NxM1. In group 3, 1.4% had N1M0, and 6.1% had NxM1. The adjusted odds ratio (AOR) of N1M0 was 0.78 (95%CI 0.74-0.82; p&lt;0.0001) in group 1 and 1.71 (95%CI 1.63-1.80; p&lt;0.0001) in group 3. Similar AOR trends were seen in NxM1 (group 1, 0.71; 95%CI 0.68-0.73, p&lt; 0.0001 vs. group 3, 1.70; 95% CI 1.63-1.75, p&lt;0.0001). (Table) Subset analysis of non-eligible patients (age &gt;70 and &lt;55) showed a similar stage migration. Conclusions: With each USPSTF recommendation, there have been significantly more diagnoses of advanced PCa; suggesting stage migration. The sequelae of having advanced PCa include more aggressive treatments, increased financial burden, and reduced quality of life. Future population studies are warranted to investigate whether the updated 2018 USPSTF recommendation now encapsulates the best target population.[Table: see text]

Impact of United States Preventive Services Task Force Recommendations on Utilization of Prostate-specific Antigen Screening in Medicare Beneficiaries

Previous studies assessing the impact of United States Preventive Services Task Force (USPSTF) recommendations on utilization of prostate-specific antigen (PSA) screening have not investigated longer-term impacts of 2008 recommendations nor have they investigated the impact of 2012 recommendations in the Medicare population. This study aimed to evaluate change in utilization of PSA screening, post-2008 and 2012 USPSTF recommendations, and assessed trends and determinants of receipt of PSA screening in the Medicare population. This retrospective study of male Medicare beneficiaries utilized Medicare Current Beneficiary Survey data and linked administrative claims from 2006 to 2013. Beneficiaries aged ≥65 years, with continuous enrollment in parts A and B for each year they were surveyed were included in the study. Beneficiaries with self-reported/claims-based diagnosis of prostate cancer were excluded. The primary outcome was receipt of PSA screening. Other measures included age groups (65 to 74 and ≥75), time periods (pre-2008/post-2008 and 2012 recommendations), and sociodemographic variables. The study cohort consisted of 11,028 beneficiaries, who were predominantly white (87.56%), married (69.25%), and unemployed (84.4%); 52.21% beneficiaries were aged ≥75. Declining utilization trends for PSA screening were observed in men aged ≥75 after 2008 recommendations and in both age groups after 2012 recommendations. The odds of receiving PSA screening declined by 17% in men aged ≥75 after 2008 recommendations and by 29% in men aged ≥65 after 2012 recommendations. The 2008 and 2012 USPSTF recommendations against PSA screening were associated with declines in utilization of PSA screening during the study period. USPSTF recommendations play a significant role in affecting utilization patterns of health services.