Abstract for: Risk Perception, Preferences and Behaviors in Cancer Screening: A System Without Negative Feedback
The introduction of Prostate specific antigen (PSA) testing has nearly doubled the lifetime risk of receiving a diagnosis of prostate cancer in the US. A substantial proportion of these PSA-detected cancers are considered to be over diagnosed cases because they would not cause clinical problems during a man's lifetime. The degree of enthusiasm for PSA screening stays high despite limited evidence of benefits and documented harms of likely treatment, while the U.S. Preventive Services Task Force (USPSTF) recently issued a draft recommendation against PSA screening for asymptomatic men, regardless of their age, racial or ethnic group (USPSTF, 2012). Our purpose is to document the forces of reinforcement that have occurred for screening and treatment decisions in prostate cancer, to illustrate the consequences of enthusiasm in clinical decisions for screening and treatment of prostate cancer in the US context, and to suggest potential ways to alleviate the future harms of over diagnosis and overtreatment of prostate cancer in US men.