Tuesday, March 27, 2007
Why "wait and see" doesn't fly with the American public
A story from the Washington Post about the ambiguity of mammogram readings. "Wait and see", or the conservative, evidence-based approach, clearly is taking a hit in this piece. A breast MRI to confirm an ultimately harmless finding is demanded by the patient.Essays like this, which perpetuate the falsehood that more testing equals better medicine, simply serve to further drive up health care costs. (via The WSJ Health Blog)
Posted by Kevin |
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Comments:
My hunch is that this particular woman would have gone insane having to wait four to six months.
# posted by 
: 10:10 AM
: 10:10 AM
Of course if the woman had National Health Care she would wait at least four to six months for the MRI anyway.
# posted by : 10:13 AM
: 10:13 AM
Ironically, "wait and see" was clearly the correct approach to take for this patient (not that she would EVER believe that).
# posted by : 1:33 PM
: 1:33 PM
Well, up against all the Anonymous commenters, who may be male or female, I'll jump in, anyway. If I ever have an ambiguous mammogram and am told to wait four to six months, I will immediately think of the women I once knew who were told the same thing--or, similarly, "it's just a calcium deposit"--and were dead within two or three years. Were they exceptions? I have no idea. Two or three months would be hellacious for me; four to six months, out of the question. Either way, I would, I'm sure, take my xrays elsewhere for a second opinion.
And for as long as I have a choice, I won't live under National Health Care. The motto of the insurance industry in such a system (even some companies in our own) must be, "Wait long enough, and the patient may die. That's better for us."
And for as long as I have a choice, I won't live under National Health Care. The motto of the insurance industry in such a system (even some companies in our own) must be, "Wait long enough, and the patient may die. That's better for us."
"Wait-and-see" might be the appropriate course if the next step is an invasive test. But face it, the only objection to the breast MRI is cost. The test is not painful and it is not invasive and it gives very useful information.
It is not only a useful for high risk women, but is in fact going to identify breast cancer better than the mammogram in many instances. ( though xray does have it's own plusses) I predict it will become used more generally for screeing in average-risk women.
For now, if told to wait and see, I would get the MRI, even if I had to pay out of pocket.
Peace of mind has, oddly, no value when discussing the merits of a test. This aspect of sensitive and specific tests needs to get its due.
It is not only a useful for high risk women, but is in fact going to identify breast cancer better than the mammogram in many instances. ( though xray does have it's own plusses) I predict it will become used more generally for screeing in average-risk women.
For now, if told to wait and see, I would get the MRI, even if I had to pay out of pocket.
Peace of mind has, oddly, no value when discussing the merits of a test. This aspect of sensitive and specific tests needs to get its due.
# posted by : 8:26 AM
: 8:26 AM
But face it, the only objection to the breast MRI is cost.
Really? For me it would be false positives and, more importantly, potential for overdiagnosis. Ever heard about it? There is a significant risk of it even with mammograms, but with MRI it is likely to be much higher. Also while MRI is not invasive, its rate of false positives and resulting biopsies is much higher than for mammograms.
Overdiagnosis leads to overtreatment, treatment has side effects that may include heart problems and possible secondary malignancy. Not to mention surgery.
So for every life that'll be saved, several women will hear a dreaded word 'cancer' they would've never heard otherwise. Happens now with mammograms. I'd be curious how much more of it there'd be with MRIs. It is one thing when you talk about high-risk women; but once you talk about women in average risk, the potential of harm is much higher while that of benefit is lower.
Really? For me it would be false positives and, more importantly, potential for overdiagnosis. Ever heard about it? There is a significant risk of it even with mammograms, but with MRI it is likely to be much higher. Also while MRI is not invasive, its rate of false positives and resulting biopsies is much higher than for mammograms.
Overdiagnosis leads to overtreatment, treatment has side effects that may include heart problems and possible secondary malignancy. Not to mention surgery.
So for every life that'll be saved, several women will hear a dreaded word 'cancer' they would've never heard otherwise. Happens now with mammograms. I'd be curious how much more of it there'd be with MRIs. It is one thing when you talk about high-risk women; but once you talk about women in average risk, the potential of harm is much higher while that of benefit is lower.
# posted by : 9:49 AM
: 9:49 AM
I hear people talking about MRI's but what about an ultrasound test instead? Is it really that much more expensive? Does it do a better job of finding problems? Just curious to know.
Interesting to read this woman's story in light of today's news on MRI's now being recommended for some women. I agree with Vicki - I'd at least get a second opinion before waiting that long. I may only be in my early 40's but know too many women my age, and younger, who have waited and regretted that decision.
LOL... Funny what difference a day makes. With MRIs shown to be clearly superior in detecting breast cancer, this woman was not only right in her concerns (and the doctors who "know better" wrong), but also right in demanding an MRI.
I love it!
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I love it!
# posted by : 6:54 AM
: 6:54 AM
