Simple Interventions May Increase Prostate Cancer Screening

 Findings also have implications for primary care practices

San Diego, July 10, 2007 – Prostate cancer is the most common cancer in American men, with an estimated incidence of 234,460 cases and 27,360 deaths in 2006. Screening for prostate cancer remains controversial due to insufficient evidence to recommend for or against screening. In particular, strategies for encouraging discussion of prostate cancer in high-risk populations have not been tested. In a study published in the August issue of the American Journal of Preventive Medicine, researchers examined the effects of two low-literacy interventions on discussions about, and screening tests for prostate cancer.

An inner-city primary care clinic was the setting for this study of 250 men age 45-70 with no prior history of prostate cancer. Over 90% of the subjects were African-American and about 79% read below 9th grade level. Patients received either a detailed educational handout about prostate cancer screening (PtEd group), a simple handout encouraging them to talk to their doctor (Cue group), or a control handout (control group). None of the interventions advocated for or against screening.

After each patient had seen a physician or nurse practitioner, an interviewer (blinded to which intervention had occurred) asked a series of questions about what was discussed with the caregiver. Participants were also assessed for their health literacy using the Rapid Estimate of Adult Literacy in Medicine (REALM) test. The interviewer also determined whether a Prostate Specific Antigen (PSA) test was ordered that day, or whether a Digital Rectal Exam (DRE) was done.

While 48% of all patients reported discussing prostate cancer, 58% of the Cue group and 50% of the PtEd group reported discussions, against only 37% of the control group. Further, when prostate cancer was discussed, both the Cue group (40%) and the PtEd group (48%) initiated the conversations, compared to only 10% of the control group.

Writing in the article, Sunil Kripalani, MD, MSc, Emory University School of Medicine, notes, "These findings also have implications for primary care practices, where strategies are needed to promote discussion of prostate cancer and personalized decisions about screening options. Prior research has examined multimedia aids and other interactive strategies to foster informed decision-making. While generally effective, such approaches may be difficult to implement on a large scale, particularly in health care settings that have limited resources, including many clinics that provide care to underserved minority populations. By contrast, the present approach appears simple and effective, and it could be scaled up at relatively low cost."

Dr. Kripalani believes the present findings demonstrate "that such patient interventions are effective across literacy levels, and they work primarily by empowering patients to raise the topic of discussion."

The article is "Low-Literacy Interventions to Promote Discussion of Prostate Cancer: A Randomized Controlled Trial" by Sunil Kripalani, MD, MSc, Jyoti Sharma, MD, Elizabeth Justice, MD, Jeb Justice, MD, Cynthia Spiker, MPH, Larry E. Laufman, EdD, Terry A. Jacobson, MD, Megan Price, MS, and Armin D. Weinberg, PhD. It appears in the American Journal of Preventive Medicine, Volume 32, Issue 8 (August 2007) published by Elsevier.

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Full text of the article is available upon request; contact to obtain copies. To request an interview with the lead author, please contact Sarah Goodwin, Assistant Vice President, Health Sciences Communications, Woodruff Health Sciences Center, Emory University, 404-727-3366 or

About the American Journal of Preventive Medicine
The American Journal of Preventive Medicine is the official journal of The American College of Preventive Medicine and the Association for Prevention Teaching and Research. It publishes articles in the areas of prevention research, teaching, practice and policy. Original research is published on interventions aimed at the prevention of chronic and acute disease and the promotion of individual and community health. The journal features papers that address the primary and secondary prevention of important clinical, behavioral and public health issues such as injury and violence, infectious disease, women's health, smoking, sedentary behaviors and physical activity, nutrition, diabetes, obesity, and alcohol and drug abuse. Papers also address educational initiatives aimed at improving the ability of health professionals to provide effective clinical prevention and public health services. The journal also publishes official policy statements from the two co-sponsoring organizations, health services research pertinent to prevention and public health, review articles, media reviews, and editorials.

The American Journal of Preventive Medicine is ranked 11th out of 98 Public, Environmental & Occupational Health titles and 16th out of 103 General and Internal Medicine titles according to the Thomson Scientific Institute for Scientific Information's 2006 Journal Citation Reports.

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