Home > Health care, Media fail > To screen or not to screen….

To screen or not to screen….

Lots of older Americans are undergoing colon cancer tests they don’t need, putting themselves at risk and costing Medicare money it shouldn’t be spending. But when your doctor refers you for screening, don’t you go?

And what happens when screening recommendations change but medical practice doesn’t?

Half the patients in a new colonoscopy study had the test less than seven years after getting a normal result from an earlier test. But the U.S. Preventive Services Task Force (USPSTF) recommends this test every 10 years, starting at age 50, provided you’re not considered high-risk and your initial test is normal.

Also, about 1/3 of patients over 80 were getting repeat exams within seven years, even though the test isn’t recommended at all for that age group if prior results were normal.

Not only is excessive testing risky and costly, screenings for people who don’t need them make testing resources less available for people who do, said Robert Smith, director of cancer screening at the American Cancer Society.

Even so, ACS still endorses routine annual mammograms for women in their 40s, although the USPSTF changed its recommendations in 2009 to say women shouldn’t start this form of breast cancer screening until their 50s.

Not surprisingly, a new study finds that 30% of women in their 40s are confused about when to get a mammogram, due in part to media coverage. Examining print and broadcast media and blogs, the study authors found that negative coverage of the 2009 recommendations outweighed positive coverage by 3 to 1.

Of course, controversy is mother’s milk to the media, and there was lots of controversy when the revised breast cancer screening guidelines were announced. A recent poll found that most women think they should start getting mammograms in their 40s, with 2/3 not aware that the Task Force recommendations don’t support this.

The risk-benefit calculus is statistical, after all. A study that accompanied the 2009 recommendations found that doctors would have to screen 1,904 women ages 39-49 for a decade to prevent one death. As USA Today reported,

[A]fter 10 mammograms, more than half of fortysomething women will have a “false positive,” which occurs when a mammogram detects something suspicious that turns out to be benign….Suspicious findings cause anxiety and may lead women to undergo painful needle biopsies. Studies also suggest that 1% to 10% of cancers found through mammograms turn out to be essentially harmless, because they will never prove life-threatening.

Categories: Health care, Media fail
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