Do Cancer Centers Push Too Many Tests?

Suppose you receive an email with a postcard that is a reminder to book a mammogram. Alternatively, a primary care doctor may order a PSA test to screen for prostate cancer in a man or tell him that he needs to be screened for lung cancer because of his many years of smoking.

These patients can search for cancer centers online in an attempt to inform their customers and learn more about screening, recommended times and subjects.

That may not be the best bet. The United States Preventive Services Task Force, which is independent of the Medical Society, publishes guidelines on who and how often to be screened for lung, prostate, and breast cancer, among other preventive recommendations. However, according to three studies recently published in JAMA Internal Medicine, cancer center websites often differ from these recommendations.

Researchers have found that some sites discuss the benefits of screening, but barely mention the harm and risk. Some have provided recommendations on the age at which screening should begin, but elaborated on when to stop. This is important information for the elderly.

Dr. Behfar Ehdaie, a urologist and author at the Memorial Sloan-Kettering Cancer Center in New York, said: Study of Prostate Cancer Screening Recommendations..

Screening refers to testing patients with no evidence of symptoms or illness, such as prostate-specific antigen testing, mammograms, colonoscopy, and CT scans.

Researchers have analyzed the websites of more than 600 cancer centers that offer prostate screening recommendations and found that more than a quarter recommend screening for all men. More than three-quarters did not specify the age at which regular inspections would be discontinued.

But guidelines from both Preventive Medicine Expert Committee And that American Urological Association According to Task Force guidelines, men over the age of 70 should not be screened on a regular basis, as “potential benefits do not outweigh the expected harm.”

For men between the ages of 55 and 69, both groups encourage individual decisions after discussing the benefits and harms with the clinician. However, neither group recommends regular screening of young men at average risk.

In addition, according to this study, 62% of cancer center websites did not contain information about the potential harm of screening. Prostate cancer grows slowly and often does not cause problems. However, detection and treatment can cause surgical and radiation complications, such as incontinence and poor quality of life due to sexual dysfunction.

The survey found similar problems on websites discussing other cancer screenings.and More than 600 Breast Cancer Center StudiesOver 80% of those who recommended a starting age and interval for screening mammograms were inconsistent with the guidelines. The survey did not mention whether the website contained information about when to stop.

The 2016 Guidelines for the Committee on Preventive Medicine, Currently being updated, but it is recommended that women aged 50-74 years be screened for mammograms every other year. It turns out that there is insufficient evidence of benefit and harm for people over the age of 75. The American Cancer Society As long as life expectancy is 10 years, we recommend annual or biannual screening for women over the age of 55 who have life expectancy.

But lung cancer screening Recommended only for high-risk people Due to smoking history and old age. even here, Analysis of 162 Cancer Center Websites About half showed that they did not deal with the potential harm.

“I think it’s important to provide a balanced explanation,” said Dr. Danielle Jonas, an internist at Ohio State University School of Medicine and lead author of the study. “It is no exaggeration to say that they can do a better job.”

Concerns about overtesting and overtreating certain cancers in the elderly have been around for years. “The harm of screening is early,” said Dr. Mara Schonberg, internist and healthcare researcher at the Beth Israel Deaconess Medical Center in Boston. However, the benefits of screening can occur years later. Elderly patients with other health problems may not live long enough to experience them.

For example, in mammography, harm includes false positives, leading to repeated mammograms and biopsies. Psychological effects Dr. Schonberg’s research shows that it can last for several months.

And while most breast cancers diagnosed in women over the age of 70 are at very low risk and may never progress, “almost everything Treated by surgery“We may then use radiation and endocrine medications,” said Dr. Schonberg, all of which can cause negative side effects.

For benefits, the data showed that: 1,000 women aged 50-74 You need to undergo mammography for almost 11 years to prevent one person from dying from breast cancer.

Why do some cancer center websites omit the possibility of false positives, repeated tests, radiation exposure, and the aftereffects of surgery? Why doesn’t it contain information about how many life screenings are actually saved at a particular age?

Dr. Alexander Smith, a palliative medicine specialist and geriatrics researcher at the University of California, San Francisco, said: The radiology required for both lung and breast screening is “one of the biggest money-making in the healthcare system,” he said.

Dr. Jonas added that some websites may have been developed by marketers with little information from medical professionals. Talking about risks can discourage patients from clicking the “book” button.

On the other hand, it can be difficult to discourage screening of older patients, even if the study shows little effect.

Dr. Schonberg has developed and tested decision support, a pamphlet that helps women over the age of 75 and their physicians reach evidence-based conclusions about mammograms.

To some extent They work.. Older women who receive the pamphlet are more knowledgeable and tend to discuss benefits and risks with their doctor. They are less likely to continue screening. However, over 18 months, about half of women who received decision support received mammograms, and 60% of those who did not.

Dr. Schonberg described it as a habit or a “need for peace of mind.”Patient may also Overestimate them Risk Level; She pointed out that an average 75-year-old woman has a 2% chance of being diagnosed with breast cancer in 5 years.

In addition, screening choices include a problem that some older patients (and doctors) want to avoid: life expectancy. The American Cancer Society and some medical groups use a 10-year life expectancy rather than an age limit as a guideline for when older patients can stop screening.

“Prognosis is one of the key factors in decision making,” said Dr. Smith. “Are patients going to live long enough to experience the benefits?” It can be an unpleasant conversation that includes age, health, and mortality.

How should older people inform themselves about cancer screening?In addition to discussing pros and cons with doctors — Medicare requires such a visit before covering lung cancer screening — patients US Preventive Services Task Force website For the latest evaluation.

They can also be used ePrognosis, An online guide created by Dr. Schonberg, Dr. Smith, and colleagues at UCSF 10 years ago. Most visitors are medical professionals, but patients can also use the site’s calculator to determine if they may benefit from breast and colon cancer screening. They can use questionnaires to help determine their life expectancy and some decision support.

Of course, patients can also visit the Cancer Center website, but they need to figure out what’s missing.