New IBME Study Reveals Major Gaps Between Public Perceptions and Evidence on PSA Screening
A new study from the Institute of Biomedical Ethics and History of Medicine (IBME), published in Social Science & Medicine, examines how Swiss men evaluate the benefits and harms of prostate-specific antigen (PSA) screening, and reveals a marked divergence between public expectations and established clinical evidence (see: Perceptions and Misconceptions of PSA Screening in Switzerland).
Surveying 425 men aged 55 and older, the research team, Giovanni Spitale, Federico Germani, and Nikola Biller-Andorno, found that participants dramatically overestimated the life-saving potential of PSA screening. While current evidence indicates that screening prevents roughly 3 deaths per 1,000 men screened, respondents’ median estimate was 50, with many expecting hundreds of prevented deaths.
The study also shows that over half of participants would support screening even in a hypothetical scenario where it prevents no deaths, highlighting the powerful influence of personal experience, reassurance, and beliefs about early detection. Men with a history of PSA testing or cancer were especially likely to endorse screening across all scenarios.
These findings underscore the limits of information-only approaches in supporting informed decision-making. Even when presented with accurate data on overdiagnosis and overtreatment, many participants maintained an unwaveringly positive view of PSA screening.
To address this gap, the authors introduce preference epidemiology (see also: Introducing Preference Epidemiology), an emerging framework for systematically studying how populations evaluate medical trade-offs. By identifying thresholds of acceptability and mapping where perceptions deviate from evidence, preference epidemiology can help design value-sensitive, ethically grounded health communication and screening policies.