Friday, May 16, 2008
More medicine isn't better
Predictable:New techniques for detecting breast cancer may be leading more women to have their entire breast removed . . .Don't want to say I told you so, but:
. . . one possible explanation is that magnetic resonance imaging, which is relatively new, detects more possibly cancerous growths than does mammography. That could be causing patients and doctors to conclude that a lumpectomy, which removes just the part of the breast containing the primary tumor, may not be sufficient.
Every test has the risk of a "false positive," which is a positive test in the absence of disease. Doctors generally act on every abnormal result, so a simple X-ray finding could lead to further tests, such as an advanced imaging scan or biopsy. When you consider that a CT scan can expose patients to radiation equivalent to several hundred X-rays, and a biopsy might have serious complications such as bleeding or infection,there comes a point where increasing the frequency and degree of diagnostic studies could lead to harm.More tests lead to more procedures, which doesn't always help patients.
Posted by Kevin |
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While your assessment about wasted medical dollars and false positive tests is dead-on accurate, and breast MRI suffers from the same lack of specificity that plagues many diagnostic testing, this reality isn't related to the increased rate of mastectomies. These are true positive results - actual cancers in other parts of the breast detected by MRI - cancers that went previously undetected by conventional methods. This leads to upstaging of patients and recommendations for mastectomy rather than lumpectomy and radiation (which was previously treating these occult cancers). Radiologists love to pat themselves on the back for all this increased detection (you should see the broad smiles on their face when they present these cases at CME courses) but nobody's bothered to figure out if these upstaged patients are living any longer. Granted, our experience has been short-lived but let's not throw any victory parties until we've satisfied the gold-standard of statistics - a mortality reduction. It's even counterintuitive to think that there would be a mortality reduction given the extensive research demonstrating that lumpectomy and mastectomy patient's have the same mortality rates. It seems like this is a case of "ignorance is bliss".
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