News
Update: Medpage Today has an excellent, brief summary about the decline in cancer.
News/Commentary
This report underscores why there was an uproar over the U.S. Preventive Task Force’s original recommendation that women start mammograms 10 years later.
A group of cancer and health organizations has published a report showing a decline in cancers for which screening works. An example of one that does not, named below, is cancer of the liver. Early detection of liver cancer often is a coincidence. Doctors are looking for another problem and find it instead, or in addition to, another diagnosis. Liver cancer tends to show up late.
Too many people with personal experiences with cancer screening know it worked for them.
In the view of the task force, mammograms can result in too many false positive results (the test says the patient has cancer and she does not) or treatment which is too aggressive for the type of cancer the woman has (cancer is classified by stage and then type). Too few lives are saved in relationship to the kinds of costs these events add up to—personal, needless fears but, yes, the cost of the tests and/or treatment.
(Disclosure: This writer’s physician recommends mammograms every two years, which the task force also recommended, but also favors breast self-exams, which the task force found to be unproductive. The difference between my doctor’s advice and the task force’s advice is that there is no question he has my best interests in mind. The question of whose interests the task force represents still needs to be clarified.)
After the uproar over the task force’s advice to delay mammograms to age 50, this body clarified what its own statement called a “poorly worded” recommendation to say that women should get mammograms at any time after 40 if they wish but the recommended age is 50-74.
How does one calculate costs?
In lives saved?
In dollars saved?
Both?
This issue with the U.S. Preventive Task Force is not over. Had a recommendation been issued for a diagnosis too complex or too rare for people to understand, there would not have been this backlash. There have been some strong statements from a number of doctors opposing the backlash and warning that medicine should not be politicized. No, it should not be, but the task force made this political with its inept communication about a highly-charged, frightening diagnosis. It felt like rationing in a bad economy and with health care reform front and center. Had they wanted to serve the opponents of health care reform, they hardly could have been more effective.
For these federal recommendations to be accepted in the future, there will have to be more transparency about the members of the task force and their qualifications in the clinical area for which recommendations are being developed. We need to know more about what their charge is in general and specifically.
We need to know what the costs—physical, personal and financial—are to each party when screening recommendations are made.
Everyone has a stake in bringing down health care costs, directly or indirectly.
Please note that this story says that there are three keys to reducing cancer deaths:
1. Reduce risk. (Prevent people from starting to smoke. If they smoke, help them quit.)
2. Early detection. (Logic would suggest that the earlier a doctor finds a disease, the easier and less expensive it should be to treat it. Maybe. Maybe not. Someone identified in the earliest stage of disease needs tests and monitoring for a specific period or for the rest of their lives. They may need treatment. This is the problem the U.S. Preventive Task Force had. Too much testing and treating for what it viewed as not that many lives saved.)
3. Develop therapies. (New therapies tend to be costlier for many reasons there is no reason to examine here. Take that as a given.)
“Cancer diagnoses and deaths continued to decline in the U.S., according to the latest available data, helped by efforts to reduce risk, provide early detection and develop therapies. (Emphasis added)
“The report, from a group of cancer and health organizations including the National Cancer Institute, trumpets the successes of improved screening and comes amid calls for less and later screening for breast and cervical cancers. A federally funded task force created an uproar last month when it said women could wait until they are older to begin routine mammograms and have them less often, a call echoed by a similar pronouncement on cervical-cancer screening from the American College of Obstetricians and Gynecologists. (Emphasis added)
“Driving the drops in cancer diagnoses and deaths are declines for the three most common cancers in men—lung, prostate and colorectal—and for two of the three leading cancers in women—breast and colorectal, according to researchers from the group of health organizations. (Emphasis added)
“New diagnoses for all types of cancer combined in the U.S. fell on average almost 1% per year from 1999 to 2006. Cancer deaths decreased 1.6% a year from 2001 to 2006. Overall cancer rates continue to be higher for men than for women, but men experienced the greatest declines in new cases and deaths. “Progress has been more limited for certain types of cancer, including many cancers that are currently less amenable to screening, such as cancer of esophagus, liver and pancreas,” said Betsy Kohler, executive director of the North American Association of Central Cancer Registries.” (Emphasis added)
Source: Wall Street Journal, December 8, 2009
Source (Update): Medpage Today, December 8, 2009
