For years we were pounded with the importance of routine screening to catch cancer and other serious diseases early when they are most treatable. Now, we are often being told not to screen because of the risk of false positives. Latest example has the experts recommending against routine ovarian cancer screening. Perhaps so as to this particular test–doctors have been saying this for several years–but this whiplash-inducing general U-turn about routine screening does not give cause for a lot of trust in guidelines.
In today’s San Francisco Chronicle, that reeducation process continues. A cardiologist named Rita Redberg weighs in generally against screening for cancer, bone density, and heart disease. But a big part of the issue seems to be money. From, “It’s Time to Rethink Overtreatment:”
UCSF’s major medical journal, the Archives of Internal Medicine, started the “Less is More” series two years ago. There are cases in the Less is More series where even physicians were unable to say no to treatment they didn’t really want or need. Remarkably, so many people are now getting medical imaging, and as a result being exposed to unhealthy levels of radiation, that the procedure is the leading environmental cause of breast cancer.
The most important reasons to avoid overtreatment are that it leads to needless suffering and harm, but it is also hard to ignore the cost of waste in our health care system, which is estimated to exceed $750 billion nationally. That’s enough to pay two years of college tuition and fees for every American between the ages of 18 and 24.
But some people do benefit from such screening. We just don’t know ahead of time who they are and who will be harmed by a false positive. Anecdotally, I know two people well whose cancers were detected in the last few years because of asymptomatic routine screening of the kind now being actively discouraged.
Pardon my cynicism: But when we had fee for service health care it was EARLY DETECTION! EARLY DETECTION! EARLY DETECTION! Now, that cost containment is all the rage, it is FALSE POSITIVES, FALSE POSITIVES, FALSE POSITIVES! Perhaps that is because the emphasis used to be on saving the lives of the relatively few caught by routine, asymptomatic screening, deemed worth the risk of false positives and the costs associated therewith. Now, the benefit of the doubt is on saving money from reacting to false positives. But that means some individuals could well die who might otherwise have lived.
Bottom line: I don’t trust these guidelines or the cost containment motives behind them. I trust my doctor.