US - world outliers when it comes to screening rates

I've been asked by students in the past, "How much do we screen for prostate cancer in the US compared with other countries?" Now there are some new numbers to help answer that question.

An article in HealthAffairs (Cancer Screening And Age In The United States And Europe. Howard et al. Health Affairs.2009; 28: 1838-1847- subscription required for online access) compares screening rates in the US and in Europe on a number of different screening tests.

But the prostate screening results jumped out at me.

In 50-64 year old men, we screen more than any European country except Austria - and that's a close call. In men this age, we screen twice as much as Finland, Sweden and Spain - almost three times as much as the Netherlands, and almost four times as much as Great Britain and Greece. We screen a whopping 7.5 times more than Denmark in this age category.

In the 65-74 year old category we screen more than any European nation - by far.

And in men 75 and older, we screen more than any European country except - again, Austria.

Some, of course, will say this is a good thing.

I don't think we can know that unless we know the rate of truly informed decisions that led up to these screening tests.

And, as previously reported on this blog, a recent Archives of Internal Medicine study showed that the quality of discussions between US men and their doctors on prostate cancer is not optimal. The authors wrote:

The finding that 30.1% of subjects underwent PSA testing without first discussing screening... is a disconcerting finding. Only 20.6% of discussions presented both the pros and cons of screening and elicited the subject's preferences for testing.

And, as the HealthAffairs authors point out, we're paying for this: "The results point to an overlooked source of high U.S. per capita health spending: the U.S. health care system pursues a more aggressive approach to detecting and treating patients with subclinical disease."