Overtreatment

RECENT POSTS

Many Older Breast Cancer Patients Receive Unnecessary Radiation Treatment

New evidence on the effectiveness of medical treatments can take a long time to be adopted by doctors.(Getty Images)

New evidence on the effectiveness of medical treatments can take a long time to be adopted by doctors.(Getty Images)

By Patti Neighmond, NPR

Cancer doctors want the best, most effective treatment for their patients. But it turns out many aren’t paying attention to evidence that older women with early-stage breast cancer may be enduring the pain, fatigue and cost of radiation treatment even though it doesn’t increase life expectancy.

Radiation had no impact on survival rates in older women with early-stage cancer.

Researchers from Duke University Medical Center analyzed the impact of a large randomized trial published in 2004 that compared treatment options for women over the age of 70 with early-stage breast cancer. That study compared cancer recurrence and survival rates among women who had surgery, chemotherapy and radiation with that of women who had surgery and chemotherapy only.

While there was a slight decrease in recurrence of cancer in the group who had radiation, there was no difference in survival, thus raising the question of whether radiation treatment for this group of patients is worthwhile. Continue reading

Put Down the Heating Pad: Physical Therapists Say It Doesn’t Help

Physical therapy is about being, well, physical, new guidelines say. (Getty Images)

Physical therapy is about being, well, physical, new guidelines say. (Getty Images)

By Nancy Shute, NPR

I have fond memories of listening to NPR while lounging at the physical therapist’s with a heating pad on my shoulder. Don’t do that, the nation’s physical therapists’ association says.

Heat therapy, electrical stimulation, ultrasound and other “passive physical agents” almost never help, according to a list released Monday by the Choosing Wisely campaign. Instead, they siphon time and money away from what you really want from a physical therapist — an exercise program that will restore strength and mobility.

Well, this is certainly going to make physical therapy less restful.

But seeing as I’ve been to several physical therapists over the years and they’ve all used this stuff, the fact that the American Physical Therapy Association put passive physical agents on top of their list of things not to do seems like big news. Continue reading

New Guidelines Say Many Women Can Skip Pelvic Exam

(Maigh/Flickr)

If this picture makes you shudder, you’ll want to understand the new guideline. (Maigh/Flickr)

No more dreaded pelvic exam? New guidelines say most healthy women can skip the yearly ritual.

Routine pelvic exams don’t benefit women who have no symptoms of disease and who aren’t pregnant, and they can cause harm, the American College of Physicians said Monday as it recommended that doctors quit using them as a screening tool.

It’s part of a growing movement to evaluate whether many longtime medical practices are done more out of habit than necessity, and the guideline is sure to be controversial.

Scientific evidence “just doesn’t support the benefit of having a pelvic exam every year,” said guideline coauthor Dr. Linda Humphrey of the Portland Veterans Affairs Medical Center and Oregon Health & Science University. Continue reading

Yes, It’s A Headache. No, I Didn’t Need That Brain Scan

Headaches are almost never caused by a tumor, say neurologists. (Getty Images)

Headaches are almost never caused by a tumor, say neurologists. (Getty Images)

Over at NPR, the Shots blog reports that Americans get $1 billion (yes, with a “B”) worth of brain scans every year — because they have a headache. That’s according to research at the University of Michigan.

Headaches are one of the most common reasons people go to the doctor  — up to a quarter of all doctor visits, says Shots.

Sending a billion dollars “down the drain.” Annually.
Presumably people are getting the scans because they’re worried that headache is a sign of something much more scary — say a brain tumor.

There’s just one problem. Most headaches are just that — a headache.

From the Shots post: Continue reading

When Treating ‘Stage Zero Breast Cancer,’ Can Less Be More?

By Patti Neighmond and Richard Knox, NPR

Peggy MacDonald of Portland, Ore., chose not to have surgery for DCIS.

Peggy MacDonald of Portland, Ore., chose not to have surgery for DCIS.

 

When Sally O’Neill’s doctor told her she had an early form of cancer in one of her breasts, she didn’t agonize about what she wanted to.

The 42-year-old mother of two young girls wanted a double mastectomy.

In many cases it doesn’t ever progress to invasive cancer, the type that can be life-threatening.
“I decided at that moment that I wanted them both taken off,” says O’Neill, who lives in a suburb of Boston. “There wasn’t a real lot of thought process to it. I always thought, ‘If this happens to me, this is what I’m going to do.’ Because I’m not taking any chances. I want the best possible outcome. I don’t want to do a wait-and-see.”

Today, 10 years later, O’Neill has no regrets about what most people would consider a radical decision. And as it turns out, she was at the leading edge of a trend.

O’Neill had ductal carcinoma in situ, or DCIS. The number of women who get double mastectomies because of DCIS is small – around one in 16 women (see accompanying chart). But the rate has doubled in the past 10 years. Continue reading

Cutting Down on Cancer Overdiagnosis: National Panel Weighs In

Ductal carcinoma in situ seen under a microscope. While doctors also call it Stage 0 Breast Cancer, in an article Monday, doctors argue it should no longer be labelled "cancer." (Ed Euthman/Flickr)

Ductal carcinoma in situ as seen under a microscope.  Doctors also call D.C.I.S. “Stage 0 Breast Cancer.” But in an article Monday, a panel of national scientists argue it should no longer be labelled “cancer.” (Ed Euthman/Flickr)

What power does a word have? If the word is “cancer,” for most people it packs a wallop of emotion ranging from general anxiety to abject terror. For the last 30 years, a large industry has grown and developed with a focus on awareness and screening. The goals were laudable: get screened; catch cancer early; early diagnosis means patients dodge a death sentence.

There’s just one problem. It’s not working. This notion of screening was dependent upon the understanding of cancer 30 years ago: that cancer started from a tiny seed and steadily grew and spread until – without treatment – it killed the patient.

But today scientists know that not all cancers behave this way. Some are fast-growing, some may grow slowly, but progressively. But others are “indolent,” so slow-growing, they will never cause the patient harm.

So what certain cancer screening tests have wrought (think mammography, PSA tests) is a dramatic increase in diagnosis of early-stage disease without a corresponding decline in death rates from cancer or diagnosis of late-stage disease. Many of these early stage patients are likely “overdiagnosed” and then “overtreated” — for cancers that may never have grown and spread.

“We terrify (women) with D.C.I.S. thinking they have cancer. We could wait six months to see if something changes without making people hysterical.”
Against this backdrop, the National Cancer Institute called together a group of nationally recognized cancer doctors and researchers to review the evidence on overdiagnosis. In a Viewpoint published Monday in JAMA, the panel calls for major changes in the way the medical world classifies and thinks of “cancer” and the way screening programs are designed.

“This article is really critical for laying the ground work for introducing what I hope will be groundbreaking changes in screening and prevention,” said lead author Dr. Laura Esserman, director of the breast care center at UC San Francisco. Continue reading

Just Say No: Doctors’ Groups Define More Unnecessary Tests, Procedures

CT scan 13 of Clubs_Flickr

One new recommendation: Don’t automatically do a CT scan to check a child’s minor head injury. (13 of Clubs/Flickr)

One of the rallying cries against fee-for-service medicine is this: since doctors are paid to do things to patients (tests, procedures), they are then incentivized to do more things to patients (tests, procedures) than the patient might actually need.

On Thursday, a wide swath of medical groups joined a campaign to list tests and procedures which are commonly done but risk causing patients more harm than benefit.

This “Choosing Wisely” campaign is from a coalition of doctors’ groups — ranging from the American Academy of Pediatrics to the Society of Thoracic Surgeons — in conjunction with Consumer Reports. Last year, the campaign named 45 tests and procedures patients should look at carefully. This year, 17 doctors’ organizations representing 350,000 physicians released 90 additional tests and procedures. Continue reading

Mammograms: Strong Evidence That Every Two Years Is Best Option For Older Women

(Photo: U.S. Navy)

(Photo: U.S. Navy)

A major new study has found that — in older women — mammograms done every two years were as effective as mammograms done annually and led to far fewer false positive results.

The study, published online Tuesday in the Journal of the National Cancer Institute, included more than 140,000 women ages 66 to 89 from across the country.

Frequency of mammograms among women in their 40s and 50s has been the subject of intense debate for more than two decades, but this older group of women has been much less studied.

The women screened annually had a dramatically higher rate of false positives.
A team led by researchers at UC San Francisco sought to answer the question: among older women, if a woman is screened for breast cancer every two years, instead of every year, will a deadly cancer be missed?

“We found that there really was no difference,” Dejana Braithwaite, assistant professor of cancer epidemiology at UCSF and part of the research team, told me. “The women who were screened every two years were not at a greater risk. They did not have a higher probability of being diagnosed with late stage breast cancer compared to those women who were screened every year.” Continue reading

Pap Tests for Cervical Cancer Are Too Often Overused

Healthy cervix cells, gathered during a Pap test, as seen under a microscope. (Euthman/Flickr)

Healthy cervix cells, gathered during a Pap test, as seen under a microscope. (Euthman/Flickr)

January is Cervical Health Awareness month, and the Centers for Disease Control is celebrating by highlighting just how poorly the US is doing at following established guidelines.

In dual reports today, the CDC finds that many women are being screened for cervical cancer way too often — while other women are not screened enough.

Let’s start with the guidelines themselves. In 2012, three different groups, the US Preventive Services Task Force, the American Cancer Society and the American College of Obstetricians and Gynecologists all came to agreement: Women ages 21 to 65 should receive a Pap test — the definitive screen for cervical cancer — once every three years. If you’re either under 21 — or 65 or older, you don’t need one, barring certain limitations. (Some women opt for an additional HPV test and can be screened with a Pap test every five years.)

In addition, the overwhelming number of women who have had a total hysterectomy (in which the cervix is also removed) do not need any more Pap tests. As Dr. David Chelmow, a professor of obstetrics and gynecology at Virginia Commonwealth University Medical Center, told Reuters, “It’s tough to get cervical cancer without a cervix.”

The upshot from the CDC’s survey? Here are the numbers:

  • 41.5% of women ages 18 to 21 had a Pap test in the last year, despite the recommendations that they don’t need them Continue reading

No Evidence of Benefit from Routine Pelvic Exams

Women can add pelvic exams to list of medical tests they may not need as often — or at all

(Maigh/Flickr)

(Maigh/Flickr)

First, let’s review. We’ve been getting a lot of updates to cancer screening tests lately.

Pap Smears, a screening test for cervical cancer, were recommended to be done annually, until a group of experts in prevention concluded that every three years was equally effective. Most medical groups, including the American Cancer Society, agree on this one.

Then there’s mammography. I think everyone knows the debate around that. Every year or every other year? Starting at 40? or 50? The evidence points to every two years after age 50, although many doctors maintain younger and more often is better.

Women get them annually, even though we “lack data” that they do much for us.

But this latest one — about pelvic exams — caught me by surprise. It turns out there’s really not a whole lot of evidence that doing an annual pelvic exam makes any difference to a healthy woman’s continuing good health. (Again, we’re stressing healthy women. Women having symptoms are definitely candidates for a pelvic exam).

Here’s what the American College of Obstetricians and Gynecologists (ACOG) says about the pelvic exam, after recommending it be done annually: Continue reading