House Committee to Scrutinize the Working of USPSTF

Kirsten Bibbins-Domingo, PhD, MD, MAS, chairperson of the US Preventive Services Task force (USPSTF); John Lynch, MD, chair of the department of urology at Georgetown University; and John Meigs, Jr, MD, FAAFP, president of the American Academy of Family Physicians, are key witnesses testifying before the House Energy and Commerce Committee on Wednesday. The hearing is simply entitled, “Examining the United States Preventive Services Task Force.”

The vice chair of the committee, Congressman Marsha Blackburn, R-Tennessee, and Representative Bobby Rush, D-Illinois, authored the USPSTF Transparency and Accountability Act of 2015 (H.R. 1151), with the expectation that specialists and sub-specialists be involved in reviewing the preventive services that are examined by the task force. Additionally, the bill also mandates the creation of an advisory board with diverse stakeholder participation—including patient groups, providers, and federal agencies—to ensure that the task force makes more balanced recommendations that integrate distinct viewpoints. An additional level of regulation would be guaranteed by the submission of a report by the Government Accountability Office, comparing USPSTF’s recommendations with health guidelines developed by other federal agencies.

The committee expects to use Wednesday’s hearing as a platform to discuss stakeholder feedback received on H.R. 1151.

Several recommendations by the task force have been controversial. This includes the 2012 recommendation advising urologists and primary care physicians to stop using the prostate-specific antigen (PSA) test to screen for prostate cancer. This recommendation created confusion and push back from physicians. While a big drop in the PSA screening test utilization was observed in subsequent months, the decline was most significant among men between 50 and 70 years old—an age group most likely to benefit from the test.

Lynch, himself a prostate cancer survivor, firmly opposes the USPSTF recommendation.

“I think we would all agree that the appropriate use of PSA and [digital rectal exam], combined with informed consent, especially in at-risk populations, does indeed reduce deaths from prostate cancer,” Lynch said in a statement. “It is a disservice to men to deny them the opportunity for potential treatment and cure, when necessary, for a disease that affects 1 in 6 over the course of their lifetime.”

Lynch is also serves as the president of the American Urologic Association. In his witness statement submitted to the House committee, Lynch stated, “Rather than issuing a blanket recommendation against screening, it would be better to 'screen smarter' by testing most men at individualized intervals (not every year) and adding additional focus to how we screen men at a higher risk for disease. These decisions are best made between the physician and patient, taking into consideration their individual risk factors and family history.”

In his statement, Meigs underscores the important role of the task force, stating that it plays an important role in balancing risks and harms prior to making a recommendation, which he states, “creates important value for family physicians like me, our patients, and the nation.”

He echoed the sentiments presented by Lynch, that the final decision of whether to undergo a preventive screening test—be it for cervical cancer, colorectal cancer, or breast cancer—should be made following a conversation between the patients and their physician. According to Meigs, “H.R. 1151 undermines the Task Force by making its work to identify, evaluate, and implement patient-centered guidance more difficult.”