Health care’s third rail: Should cancer screenings be cut back?
years ago, a littleknown panel, the U.S. Preventive Services Task Force, elbowed its way into the national conversation with a startling recommendation that most women younger than 50 could forgo annual mammograms.
The finding stuck a finger in the eye of conventional wisdom. A generation or more of women had come of age believing regular screening is the best way to protect oneself from dying of cancer. Arriving in the midst of President Barack Obama’s health care reform effort, the recommendation fed into opponents’ conviction that government was trying to force its way into life-or-death decisions.
Members of Congress blasted the task force. Doctors continued to recommend mammograms, and women kept getting them.
But the findings, and the science behind them, did not go away. For more than a decade, multiple studies have advanced the argument that routine screening for some forms of cancer doesn’t prevent premature death and may do more harm than good.
The findings of a large study released on Thanksgiving Day added more weight.
Research in the New England Journal of Medicine looked at more than 30 years of U.S. health statistics. It found that mammograms are effective at detecting early stage breast tumors, but they don’t reduce the number of women diagnosed with advanced stage cancers.
The conclusion was that early detection doesn’t save lives. Rather, it prompts millions of women to undergo expensive, intrusive treatment for tumors that would never become life-threatening.
Similar mixed messages have been sounded to men about screenings for prostate cancer. Studies have found that early detection and aggressive treatment of that disease may be unnecessary, ineffective and risky.
This is the third rail of health care — the science that no one knows how to come to grips with. Not doctors, not patients, not politicians.
Is it time to rethink the value of preventive screenings and cut back on the costly diagnosis and treatment options that come with early detection?
Doctors and politicians can quibble with the accuracy and methods of individual studies. It becomes harder to push against their combined weight.
And yet four decades of doctors’ warnings and public information campaigns will not be easily undone. A vast industry of equipment, technology, expertise and advocacy built around screening and early detection won’t be easily dismantled.
Personally, I would love to skip the annual mammogram. But unless or until my doctor advises me to do so, I’m not sure I will. Studies are remote; my long-time internist is real.
The bigger dilemma comes if a mammogram or a PSA test turns up something suspicious. Research indicates that often a low-tech treatment called watchful waiting is as effective as more aggressive interventions. But that’s not how most patients or the U.S. medical system are wired.
“It’s almost as if the earlier it’s caught, the more conflict it causes for the patient,” said Jennifer Klemp, a researcher and professor at the University of Kansas Cancer Center.
The same goes for the doctor. “The worst fear for a physician is to have to make that call,” Klemp said. “They’re not trained to wait. They’re trained to do something.”
Klemp is hoping for scientific breakthroughs that will enable doctors to predict with reasonable accuracy whether an early stage tumor will develop into a deadly form of cancer. Until then, she and others on the front lines will continue to tread carefully in a terrain that is more gray than black and white.
“What they say intuitively makes sense,” Klemp said of the studies that seemingly call for less screening and intervention. “But we’re dealing with human beings.”
A West Lake Hills resident who cleared what he says were dead juniper trees from his property is accused of violating a city ordinance and could face tens of thousands of dollars in fines unless he replants trees.
Tony Lee: Big brother.
Larry Schuler: ONE more reason why I WILL NEVER LIVE IN WEST LAKE.
Laurie Pruser-Stockman: Because junipers/cedars don’t regenerate and grow wild ... STUPID STUPID STUPID ... I wonder ... is this governing body left or right leanings?
James Davis: What if it’s only a bush? Or a mere shrubbery? And does said ordinance apply exclusively to the vegetable kingdom, or