In Push for Cancer Screening, Limited Benefits

[groovedaddy]

“Don’t forget to check your neck,” says an advertising campaign encouraging people to visit doctors for exams to detect thyroid cancer.

In another cancer awareness effort, Representative Debbie Wasserman Schultz, a Florida Democrat, has more than 350 House co-sponsors for her bill to promote the early detection of breast cancer in young women, teaching them about screening methods like self-exams and genetic testing.

Meanwhile, the foundation of the American Urological Association has a prostate cancer awareness campaign starring Hall of Fame football players. “Get screened,” Len Dawson, a former Kansas City Chiefs quarterback, says in a public service television spot. “Don’t let prostate cancer take you out of the game.”

Nearly every body part susceptible to cancer now has an advocacy group, politician or athlete with a public awareness campaign to promote routine screening tests — even though it is well established that many of these exams offer little benefit for the general public.

http://www.nytimes.com/2009/07/17/health/17screening.html?th&emc=th

[lindisfarne]

1. I made a similar point on DU about waste in medical care, and some jumped all over me.

When it comes to cancer, people think any kind of testing is a good use of health care dollars but in fact, there is a lot of doubt - even when it comes to the most researched cancers, such as breast cancer. Talking to your physician isn't always the best course of action - they themselves aren't well-informed (they were (and still are) the ones passing out antibiotics left & right, even when they themselves knew a virus was more likely the explanation for many problems).
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"But in fact, except for a few types of cancer, routine screening has not been proven to reduce the death toll from cancer for people without specific symptoms or risk factors — like a breast lump or a family history of cancer — and could even lead to harm, many experts on health say.

That is why the continued rollout of screening campaigns, and even the introduction of a Congressional bill, worries some health experts. And these experts say such efforts add to the large number of expensive and unnecessary treatments each year that help drive up the nation’s health care bill. Rather than heed mass-market calls for screening, these experts urge people without symptoms or special risks to talk to their own doctors about what cancer tests, if any, might be appropriate for them.

Blanket screenings do come with medical risks. A recent European study on prostate cancer screening indicated that saving one man’s life from the disease would require screening about 1,400 men. But among those 1,400, 48 others would undergo treatments like surgery or radiation procedures that would not improve their health because the cancer was not life-threatening to begin with or because it was too far along. And those treatments could lead to complications including impotence, urinary incontinence and bowel problems.

Then there is the economic cost. There are no credible estimates for the amount that routine cancer screening contributes to the approximately $700 billion spent each year in this country on unneeded medical treatment of all types. But health policy experts say such screenings and the cascade of follow-up tests and treatments do play a role."

[Berry Cool]

2. Well, you have good company.

I actually had a doctor tell me that monthly breast self-exams are not of much use at all and she doesn't recommend them. I doubt many people will believe it, though, after all the years we have had it drilled into us that it is every woman's duty to examine her own breasts each and every month to check for "changes." But it is true.

It also seems that every time a celebrity woman gets a diagnosis of breast cancer, she goes on a big public campaign to promote mammograms and early detection. If her treatment has positive results, she goes around telling everyone that "early detection saved my life." What no one wants to talk about is the fact that early detection isn't always lifesaving, and that mammograms are far from an ideal way to detect breast cancer (in part because they involve repeated radiation).

We also hear a lot about how important it is for poor women to have affordable or free mammograms. But what good is a free mammogram that finds something in your breast that you can't afford the treatment for?

Nothing is as simple as it seems.

[tiptoe]

3. More basic for cancer vulnerability and prevention would be first testing for Vitamin D deficiency:

The US (anti)Health Insurance industry wants exclusion from obligation to cover testing costs for Vitamin D status, even though a study for W Europe projects an annual 1:19 cost:benefit from investment to test-and-supplement relative to cost savings from the "reduction in direct plus indirect economic burden of disease".

abstract: http://www.democraticunderground.com/discuss/duboard.php?az=show_mesg&forum=222&topic_id=49922&mesg_id=64326

full analysis (PDF): Estimated benefit of increased Vit D status in reducing the economic burden of disease in W Europe - x

re cancer:
"We regard this study as the definitive study of the experiment of the relationship between Vitamin D, calcium and cancer" — Cedric Garland

"75% of deaths from these cancers could be prevented with adequate intake of vitamin D3 and calcium"

Any public option health care plan should mandate testing for Vitamin D status, as a means to reduce health care costs.

Myths, FAQ, "...Vitamin D: A Real Missing Link..." Prescription=D2 vs D3, Testing, Optimal Ranges