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CHICAGO -- Prostate cancer screening for asymptomatic men was the subject of controversy as members of the American Medical Association (AMA) wound up their annual House of Delegates meeting Wednesday.
The delegates were considering a resolution sponsored by the American Urological Association (AUA), the American Association of Clinical Urologists, and the Virginia delegation to have the AMA develop model state legislation "for screening of asymptomatic men ages 55-69 for prostate cancer after informed discussion between patients and their physician, without annual deductible or co-pay."
The resolution noted that prostate cancer is the third leading cause of death in American men, and that "the American Urological Association recommends men age 55 to 69 years of age consider the benefits and harms associated with screening, and engage in shared decision-making with their physician when considering PSA screening."
The reference committee that considered the resolution recommended it be referred to the AMA Board of Trustees for further consideration. In addition to hearing mixed testimony about whether men in this age group should be routinely screened for prostate cancer, the committee noted that the U.S. Preventive Services Task Force had given such screening a "C" grade, "recommending selectively offering or providing screening to asymptomatic men[ages] 55-69 based on professional judgment and patient preferences."
The committee also noted that two AMA councils were preparing a joint report for the AMA's interim meeting in November on the issue of value-based insurance design for preventive interventions. "Your Reference Committee believes that further study into first-dollar coverage is necessary before model legislation should be considered and that our AMA should not adopt policy prior to the ... joint report [being] issued."
But some AMA members felt the association was moving too slowly. "Our AMA has existing policy supporting breast cancer and colon cancer screening tests without paying a deductible or co-pay," said Terrence Grimm, MD, speaking for the AUA. "This resolution would be important for men's health issues, so we would like to pass it rather than refer it."
Some people spoke from personal experience. "Prostate cancer -- not only does it affect the African-American population [in] higher [numbers] than others, it has also affected my family," said Sandra Gadson, MD, a delegate for the National Medical Association. "My husband is a 5-year survivor of prostate cancer, and on Monday, he lost his younger brother to metastatic prostate cancer. So I am asking for this resolution not to be referred."
But others demurred. Bill Golden, MD, a delegate for the American College of Physicians, pointed out that one specialty society has prostate cancer screening on its "Choosing Wisely" list of potentially unnecessary tests, "so I believe there is controversy and it needs to be studied."
"As a geriatrician, I deal with these issues on daily basis," said Minnesota delegate George Schoephoerster, MD, who was speaking for himself. "They're extremely complicated, and I believe this needs to be dealt with further."
The delegates agreed with Golden and Schoephoerster, voting to refer the matter for further deliberation. The House of Delegates also:
- Referred for further study a resolution calling on the AMA to advocate that the FDA put greater emphasis on conflicts of interest when selecting advisory committee members, and also advocate for a reduction in conflict-of-interest waivers granted to advisory committee candidates.
- Adopted a resolution asking the AMA to propose legislation that would eliminate federal requirements for parents to produce evidence of a disability or special dietary need before their children can receive milk alternatives. They also approved a related resolution asking the AMA to advocate that the federal government say in its dietary guidelines that meat and dairy products are optional in the diet, subject to an individual's dietary needs.
- Approved a resolution asking the AMA to work with the Centers for Medicare and Medicaid Services to shorten the yearly data reporting period under Medicare's Merit-Based Incentive Payment System (MIPS) from 1 year to a minimum of 90 days.
In other business, several AMA members also announced their candidacy for office in 2019, including House of Delegates Speaker Susan Rudd Bailey, MD, who will be running for president-elect; House of Delegates Vice-Speaker Bruce Scott, MD, who will be running for Speaker; and Lisa Egbert, MD, a member of the AMA's Council on Medical Service, who will be running for Vice-Speaker.