Quebec City doctor calls out insurance companies for prostate cancer screening
‘Overdiagnosis is today’s plague in medicine,’ says Hélène Landry, on routine prostate cancer screening
The blood test Charles Pastori had to take when he applied for life insurance from Manulife revealed something he'd rather not know: he has an elevated level of prostate-specific antigen (PSA), a sign of possible prostate cancer.
Since January 2018, Quebec's Institute for Excellence in Health and Social Services has discouraged using the PSA level as a way to establish risk or a diagnosis of prostate cancer because of the high level of false positives.
The recommendation by the institute, which analyzes the best and most efficient ways to run the health system, is based on a 2014 European study, which found that when 1,000 men were tested systematically, 140 were false positives — which is "considerable."
Pastori will need another blood test in a few months and eventually, he may require a biopsy.
"It's one of those things you can't put it out of your mind completely, ever," Pastori told Radio-Canada.
Pastori's family doctor said he's not her only patient to be tested without informed consent, which worries her, because not understanding the results can lead to undue psychological stress and even unnecessary treatment.
"Overdiagnosing is today's plague in medicine," said Dr. Hélène Landry, during an interview with Radio-Canada shortly after Quebec City Mayor Régis Labeaume announced he had prostate cancer.
Quebec's College of Physicians recommends the test should be done only if the patient asks for it and only after understanding the risks of overdiagnosis.
Landry says overdiagnosing in the context of prostate cancer, means telling a man he has cancer even though it's not going to kill him, and he'll never feel any symptoms.
She also said the risks outweigh the benefits of the test and patients have to understand that.
Pastori wasn't given the chance.
"[The nurse] told us specifically they would test for HIV, and I don't think there was ever any other test mentioned," Pastori.
In fact, the application form includes a checkbox for PSA, but it was left empty.
In an email. Manulife's senior consultant of global communications said she could not discuss any individual case.
Anne-Julie Gratton said tests are done based on the product the client wants to buy and their age.
"We make sure our tests conform to best practices in the Canadian insurance industry," wrote Gratton.
Landry says that test is not part of "best practices" in Quebec.
Landry said aside from causing undue psychological stress, there are real risks involved with being tested: unnecessary treatment.
According to the European study on which Quebec's institute for excellence based its recommendation, 30 of the 140 men who had a false positive test will suffer complications from a biopsy.
An additional 40 men will be overdiagnosed and their treatment could lead to problems, such as incontinence and erectile dysfunction, the study said.
Landry said insurance companies should be careful because they could end up in court at the wrong end of a lawsuit if someone finds out how many unnecessary procedures he's been through when his health was never at risk.
The association representing life insurance companies sent an email in response to that criticism, stating the PSA test is necessary to evaluate health risks, and it's done "fairly regularly."
Jérémy Drivet, manager of governmental relations for the Canadian Life and Health Insurance Association, wrote that policy applications are put "on hold" to allow the client to see a doctor about the results.
With files from Jonathan Lavoie