Letter to the Honorable Kathleen Sebelius, Secretary Department of Health and Human Services

Letter

Dear Secretary Sebelius:

As Members of Congress who have been very actively engaged in the effort to both develop effective screening technologies to identify prostate cancer and to ensure that appropriate treatments are available, we write today regarding an issue of utmost concern to us. As you know, on October 7, 2011, the U.S. Preventive Services Task Force (USPSTF) rendered a draft recommendation against the use of the prostate Specific Antigen (PSA) test for the early detection screening of prostate cancer absent "symptoms that are highly suspicious for prostate cancer." We are particularly concerned about the possible impact of this recommendation on populations at high risk for prostate cancer.

African American men have the highest prostate cancer incidence and mortality rates of any racial or ethnic group in the United States. According to the Office of Minority Health at the department of Health and Human Services, African Americans were 1.4 times more likely to be diagnosed with prostate cancer and 2.5 times more likely to die from prostate cancer than non-Hispanic whites. For this reason, African American men have been designated as a high risk group for prostate cancer. However, it is our understanding that the randomized clinical trial evidence cited by the USPSTF, and used in its decision to revise its recommendations regarding the use of the PSA test, did not include a statistically significant number of African Americans and possibly not even a significant number of men with a family history of hte disease, which is another high risk group.

Therefore, we are concerned that the USPSTF's recommendation may not have had enough scientific evidence with which to make a conclusion regarding the appropriate role of the PSA test to screen for prostate cancer in high risk groups. We strong urge that the USPSTF, in a public forum, provide the data and assumptions that it used to include men "regardless of ...race and family history" within its recommendation. If no compelling and conclusive evidence is available and presented to the public for review and comment, then we believe that men at high risk for prostate cancer cannot be responsibly included in the final USPSTF recommendation.

We applaud the USPSTF for raising concerns about the harms inflicted on men who are diagnosed and treated for prostate cancer when there may be no benefit from such treatment, and we recognize that African American men and all high risk men could be subject to these harms. However, we strongly believe that careful consideration must be given to the role of PSA testing of high risk groups and that the clinical evidence used in making any recommendation must include adequate representation from high risk groups.

We thank you for your time and efforts to bring increased awareness to prostate cancer and hope that someday, we cant prevent this deadly disease entirely. We certainly hope that this will be the outcome of this critical moment in the fight against prostate cancer and we stand ready to support efforts towards this goal.

Sincerely,

Edolphus Towns
Gregory W. Meeks
Elijah E. Cummings

Source