The thrust of the article is that the benefits of various screening tests including mammograms, PSA tests, colonoscopies, etc. is questionable. The cost of mammograms alone is an estimated $4 billion dollars a year. Following are excerpts of key points. For the full article, go to the New York Times website.
“According to Dr. David H. Newman, author of the book “Hippocrates’ Shadow: Secrets from the House of Medicine.” Some of those tests cause false alarms that lead to unnecessary follow-up surgery on normal breasts, at a cost of $14 billion to $70 billion over a decade, according to Dr. Newman, the director of clinical research in the department of emergency medicine at St. Luke’s Roosevelt Hospital Center in Manhattan.
Cancer awareness campaigns can be a disservice to the public by making people overestimate their risk of dying from cancer, according to Dr. Steven Woloshin, a researcher at the Dartmouth Institute for Health Policy and Clinical Practice. Thyroid cancer, for example, is a rare disease that kills an estimated 1,600 Americans a year. But the campaign called “Check Your Neck” makes it seem as if everyone should worry about the disease, Dr. Woloshin said. But there is no evidence that routine neck exams reduce the risk of dying from thyroid cancer, said Dr. Barnett S. Kramer, the associate director for disease prevention at the National Institutes of Health, which has a cancer Web site describing the potential benefits and risks of many cancer screening tests. Most thyroid cancers are so slow-growing and curable that early detection would not improve their prognosis, he said, while a rarer form of thyroid cancer is so aggressive that a surge in screening would be unlikely to have an impact on the death rate.
Dr. Ned Calonge, the chairman of the United States Preventive Services Task Force said, “There are five things that can happen as a result of screening tests, and four of them are bad.” His group consists of independent medical experts that Congress has commissioned to make recommendations, based on medical evidence, about what preventive measures actually work.
The one good result of screening, Dr. Calonge said, is identifying a life-threatening form of cancer that actually responds to timely intervention. The possible bad outcomes, he said, are results that falsely indicate cancer and cause needless anxiety and unnecessary procedures that can lead to complications; that fail to diagnose an existing cancer, which could lull a patient into ignoring real symptoms as the cancer progresses; that detect slow-growing or stable cancers that are not life-threatening and would not otherwise have required treatment; and that detect aggressive life-threatening cancers whose outcome is not changed by early detection.
Experts like Dr. Calonge say screening is useful only if, on balance, the deaths prevented by treating cancers outweigh the harm done by treatments that are not medically necessary. The problem is, most current screening tests are not sophisticated enough to determine which cancers might not require treatment — or to predict which life-threatening cancers will respond to treatment.
There are a fairly large number of comments after the article. They mainly fall into two categories. The first group takes a pragmatic approach supporting the idea of less screening to save money. The second group consists of people who were saved by early detection or lost family members due to lack of early detection. They personalize the issue and think that awareness and early detection are valuable tools in the fight against cancer.
On a personal level, I have to wonder how I would have felt if, after discovering my lump, I had been told that it would be wise to “track” it for six months before deciding on a course of action. I would have to say that I fall into the category of people who think I would rather be “doing something” than taking a “wait and see attitude”.
We could really save a lot of money if we only tested people during their “productive” years and maybe backed off testing and treatment after a certain age. Oh, say, 69 or even 79. If we are objectively talking about how to dispense limited medical care that might make sense in the abstract, but what if you or your mother are sister fall into the “don’t bother” category?
Personally, I would much prefer being given a reasonable interpretation of the odds of treatment vs. no treatment and make the choice for myself. One part of the article indicates that people might be happier in general if they didn’t know until it was too late to do anything because they would save themselves anxiety and stress. Ignorance is bliss? I don’t think so.
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Perhaps this is a precursor to rationed government health care, where one criterion for treatment might be "How old are you?" That would, of course, disregard that you have and are paying for your health insurance, your prognosis and your need for care.
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