Not all cancer screening saves lives.
I alluded to this recently in a New York Times’ Room for Debate piece, discussing why Medicare shouldn’t pay for prostate cancer screening in men over the age of 75.
And, when it comes to ovarian cancer screening, a recent study showed that annual CA-125 antigen testing and transvaginal ultrasound did not save lives. In fact, the mortality rate in the screening group was slightly higher.
Rampant, non-evidence based, cancer screening is a contributor to rising health costs, mostly from unnecessary testing stemming from false positive screenings. Also, invasive tests can lead to complications that can worsen the quality of life for patients, without ultimately benefiting them.
How can we limit cancer screening strictly to evidence-supported tests? Progressive columnist Ezra Klein places the burden squarely on physicians:
That’s why, if you want to control health-care costs, you somehow need to convince, incentivize or otherwise conscript doctors into doing it for you … as long as doctors are telling scared and uncertain patients that they need to get screened, they’re getting screened. The moment they stop telling patients to get screened, screenings will plummet.
Unfortunately, real world medicine is more nuanced than that. Everyone needs to take responsibility. Including patients, some of whom ask for evidence-bereft cancer screening.
The concept of shared responsibility was especially evident when the New England Journal of Medicine recently asked, “Why does cost-effective care diffuse so slowly?”
Although some responsibility was placed on physicians, other stakeholders were blamed as well, including patients. But it’s not entirely their fault that they believe that more medicine is better care. The media is the ultimate culprit.
For instance, if you compare the headlines for the recent breakthrough in melanoma treatment (1,000+ headlines in Google News), versus the ovarian cancer screening study (129 headlines in Google News), the disparity in coverage is striking. Especially since both studies were released on the same day.
It’s no wonder that the public believes that newer (and more expensive) medicine is better, and that earlier cancer detection always saves lives.
So, although I agree with Ezra that doctors should rely more on the evidence when ordering tests, he overstates physicians’ influence. It pales in comparison to that of major media entities, such as his employer, the Washington Post.
Kevin Pho is an internal medicine physician and on the Board of Contributors at USA Today. He is founder and editor of KevinMD.com, also on Facebook, Twitter, and LinkedIn.
