Prostate Cancer Screening in the Workplace

Abstract

Recognition of the mortality and morbidity associated with prostate cancer has resulted in einployer based screening programs. This retrospective cohort study identified the employer costs of prostate cancer screening and referrals due to abnormal test results. The subjects were 385 men enrolled in a workplace screening program at a single employer between 1993 and 1995. Screening consisted of digital rectal examination (DRE) annually for enrolled employees aged 40 years and older, plus annual prostate specific antigen (PSA) testing for those 50 and older, and those 40 and older and considered at

International Collaboration in Health Promotion and Disease Management: Implications of U.S. Health Promotion Efforts on Japan's Health Care System

“…Overall, the evidence from this review indicates that multifactorial, comprehensive worksite health promotion and disease management programs focused on multiple risk factors are likely to reduce employee risks for chronic disease. 5,[50][51][52][53][54][55][56] By extension, such interventions may be both a clinically effective and cost-effective means to deliver comprehensive risk reduction programs to additional worksites, ranging from small to large employers.…”

“…However, they do not appear to be as effective as a more intensive and expensive approach, which adds sustained, periodic individual counseling and support. [50][51][52][53][54][55][56][58][59][60][61][62] Every program included in this review that focused on a high-risk employee or condition offered individualized risk reduction counseling to high-risk employees in the context of a worksite risk education reduction for all employees. Overall, the general health promotion and disease prevention environment of a worksite appears to be a necessary but not sufficient prerequisite to engender sustained risk reductions among high-risk employees.…”

“…50,53,55,58 Such a disease management intervention needs to provide focused, consistent, sustained behavioral change, plus appropriate medical oversight. 51,52,54,[59][60][61][62][63] Such a multiple risk factor intervention model is also applicable to single risk factors, such as smoking and hypertension, and to other chronic conditions, such as stress, arthritis, musculoskeletal disorders, video display terminal and/or repetitive motion trauma and disabilities, back injuries or pain, and cancer, that constitute major clinical and cost liabilities to employers. 51,52,60 One study at Chevron by Goetzel et al 53 reported reduced pharmaceutical expenditures.…”

“…Following from this trend is the third trend, where companies conduct an observational study to track the preclinical, postclinical, and cost outcomes of participants vs. nonparticipants in comprehensive worksite programs. 51,52,58,59,61,63 Most notable are the Citibank studies conducted by Goetzel et al 50,53,56 Company-sponsored clinical and cost outcomes research is a new and positive trend.…”

“…Despite the many limitations of current methods, most research to date indicates (1) favorable clinical and cost outcomes 5,50-56,58-63 ; (2) more recent and more rigorously designed research tends to support rather than refute earlier and less rigorously designed studies 50,[53][54][55][56]59 ; and (3) rather than interpreting the methodological flaws and diversity as preemptively negative, it may be equally indicative of a robust phenomena evident in many types of worksites, with diverse employees, different interventions, and varying degrees of methodological sophistication. 51,52,55,56 In any case, even the most rigorous method cannot compensate for predictably unsophisticated interventions that do not take into account more than 2 decades of increasingly precise multifactorial, effective intervention strategies.…”