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 →
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 →
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 →
Women can add pelvic exams to list of medical tests they may not need as often — or at all
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).
The debate about the U.S. Preventative Services Task Force giving the PSA test a “D” rating was all over the morning talk shows today. But perhaps the most interesting debate happened during a commercial break. While this clip did not air, CBS fortunately recorded it.
Watch as Dr. Otis Brawley, Chief Medical Officer of the American Cancer Society, and former basketball coach Digger Phelps, who has had surgery for prostate cancer clearly articulate the two opposing poles of the PSA test.
Near the end, Phelps passionately argues against “watchful waiting,” saying the idea of having cancer is too frightening to postpone treatment. Brawley starts to make the case for informed consent, but doesn’t have time to finish in this clip.
But this is exactly the paradox of going ahead and doing the test. Brawley estimates a million men have been needlessly cured of their prostate cancer– a disease men are significantly more likely to die with and not from.
This is what’s behind the U.S. Preventive Services Task Force recommendation: if you can’t live with doing nothing in the face of a prostate cancer diagnosis, then don’t have the PSA test in the first place. You are more likely to be harmed by the treatment–the harms range from incontinence, impotence and death.
New Campaign Urges Doctors to Avoid Unnecessary Tests
(Just Us 3: Flickr)
To many patients, it may seem unbelievable that their doctors would recommend something that is completely unnecessary. But by some estimates, that’s exactly what happens a third of the time.
Yesterday a broad coalition of medical specialty groups — including cardiologists and family practitioners — as well as Consumer Reports announced a new campaign, Choosing Wisely. It’s a list of 45 tests and procedures that doctors should do much less often for one simple reason: the items on the list are unlikely to be of benefit to the patient.
The idea immediately raised questions of rationing and that’s exactly where KQED’s Forum started off this morning in discussing the new campaign. UCSF’s Dr. Catherine Lucey, who helped to spearhead the Choosing Wisely campaign, swatted that misconception away.
“It’s not rationing,” she explained. “Rationing of health care is when you deny needed care to patients. … Rationing of health care means patients could get better being given a particular drug of subject to a particular test. This is about tests that in many circumstances do not improve quality of life, do not improve quantity of life and potentially could harm patients.”