Is the test that finds the most cancers the best?

When it comes to mammograms, not always.

I’ve written previously that the major problem in cancer screening tests is that they are not specific enough. With both PSA tests looking for prostate cancer and mammograms screening for breast cancer, many lumps or lesions that are slow-growing will be diagnosed, but not necessarily lead to a patient’s death.

A good piece in the Los Angeles Times outlines the breast cancer screening issue, citing a study showing that, “mammography screening programs increased the overall number of breast cancers diagnosed but did not reduce the number of advanced cancers.”

That’s because mammograms are quite poor at finding advanced cancers that can kill patients.

Doctors are at a conundrum. Although some feel that mammograms have been “oversold,” doctors don’t know what to do about it. This oncologist sums up the situation: “On the one hand, I don’t want to push people away from mammography, but I don’t want to encourage them to have misconceptions about mammograms either.”

And, of course, there’s the elephant in the room that few acknowledge, the spectre of malpractice if a mammogram isn’t performed. Failure to diagnose a breast cancer is one of the leading drivers of medical malpractice cases, which “creates an incentive to overdiagnose breast cancer.”

So, radiologists nationwide are faced with the choice of overdiagnosis and overbiopsy, or risk facing a lawsuit.

And for many, that’s not a hard decision.

(via Schwitzer)

✓ Join 150,000+ subscribers
✓ Get KevinMD's most popular stories