http://www.kevinmd.com/blog/2008/05/more-medicine-isnt-better.html medical blog Sun, 22 Nov 2009 22:50:49 -0500 http://wordpress.org/?v=2.8.4 hourly 1 http://www.kevinmd.com/blog/2008/05/more-medicine-isnt-better.html/comment-page-1#comment-85632 Stark Raving Med Fri, 16 May 2008 23:39:00 +0000 http://clients.emmense.com/kevinmd/2008/05/more-medicine-isnt-better.html#comment-85632 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". 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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