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Re-evaluating the Benefits of Cancer Screening 253

Posted by Soulskill
from the equations-that-are-impossible-to-balance dept.
uncleO writes "An article in the NY Times describes two studies that weigh the harm caused by cancer screenings against the benefits they provide. From the article, 'Two recent clinical trials of prostate cancer screening cast doubt on whether many lives — or any — are saved. And it said that screening often leads to what can be disabling treatments for men whose cancer otherwise would never have harmed them. A new analysis of mammography concluded that while mammograms find cancer in 138,000 women each year, as many as 120,000 to 134,000 of those women either have cancers that are already lethal or have cancers that grow so slowly they do not need to be treated. ... In recent years, researchers have found that many, if not most, cancers are indolent. They grow very slowly or stop growing altogether. Some even regress and do not need to be treated — they are harmless."
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Re-evaluating the Benefits of Cancer Screening

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  • by h00manist (800926) on Monday October 31, 2011 @02:28PM (#37898030) Journal

    Seems like someone is driving a huge PR campaign for "let's not have people visit doctors and get cancer screening". It's likely actually just costing a group of HMO insurers more money to have lots of people treat cancers early and undergo lengthy treatment, and then survive, rather than have a smaller number of people detect it too late, do a short treatment, and then just die.

    After all, health services are a business. We understand. You can't just have insured people liviing a long time and making businesses lose money.

  • by Attila Dimedici (1036002) on Monday October 31, 2011 @02:40PM (#37898158)
    The thing is that cancer is not one disorder, or even just a few disorders. Heart disease can reasonably be considered one disorder (although it is probably more accurately viewed as three or four disorders). There are hundreds of different disorders that we lump together under the term cancer.
  • Re:Blood tests (Score:5, Insightful)

    by MozeeToby (1163751) on Monday October 31, 2011 @02:52PM (#37898318)

    Presumably for the reasons enumerated in the summary. Too many costly, and quite frankly terrifying, false positives. Keep in mind, when you start talk about putting everyone through a screening, whether it be for cancer or HIV or terrorism, your screen had better be crazily accurate. Imagine there's a (really exceptionally good) false positive rate of 0.1% on your hypothetical test, if you give it to every person in the US twice a year you're going to produce 74,000 false positives a year. Or to put it another way, more false negatives than there are cancer deaths.

  • by Slashdot Parent (995749) on Monday October 31, 2011 @02:56PM (#37898378)

    as many as 120,000 to 134,000 of those women either have cancers that are already lethal or

    There are a lot of cancers that are incurable, but can still be controlled for a while. Statements like this make it sound as though catching these cancers early and controlling them for a while is a worthless endeavor.

    My wife is one year into a battle with a cancer that she has only roughly a 25% chance of surviving with treatment. Without treatment, she would have been dead a few weeks after diagnosis. She is grateful to have spent the past year alive instead of dead, and of course the children and I are also grateful. I guess the point that I'm trying to make here is that treating a cancer that will most likely be lethal still has significant value. None of us would have been very happy if some government bureaucrat had told us that since the cancer was so likely to kill her, they wouldn't bother treating.

  • by robot256 (1635039) on Monday October 31, 2011 @02:58PM (#37898402)
    What people always forget when talking about the "government takeover of health care" is that there are already bureaucrats sitting between you and your doctor--the private insurance companies--and you already have limited mobility between providers, due to limited open seasons and pre-existing conditions and whatever else your employer stipulates. But instead of being handled by a government agency overseen by elected officials, you are beholden to a for-profit organization who wants everyone to pay in more than they draw out. While I'm sure there are arguments to be made that efficiency gains can be produced in a properly regulated market versus a single-payer system, I don't think the market we have meets that criteria at the moment. It will be a little better after Obamacare goes into effect, but a lot of the health insurance system is still not working in the best interests of the patients.
  • Re:indolent (Score:3, Insightful)

    by Artraze (600366) on Monday October 31, 2011 @03:06PM (#37898514)

    But what's the alternative? Just wait until someone's sick enough to warrant a cancer screening?

    Or, to be more direct, the problem isn't the _testing_, it the _reaction_. The view of cancer is too binary... You either don't have cancer or you have ZOMG CANCER. It seems to me that by making a third category of 'mostly harmless' we could really do away with #3 altogether. How could we determine that? Early detection and study. Exactly what abandoning screens would make impossible.

    Really, this is just about the money, in a couple directions:
    First, no doctor is going to volunteer "this is cancer, but it doesn't look dangerous so we'll just monitor the situation" because God help them if that person dies.
    Second, people usually spend other people's money (government, 'insurance') on the treatments, so to them it's only 'some side effects vs your life' and not also about 10% of their lifetime earnings too. Guess what they'll take? And so the people paying for these tests have come to realize that they're just a money pit: the (usually negative) test, the (potentially) unnecessary treatment, and finally just the cost of treating real cancer a year or so earlier then you would have had to without the screen for someone that may well die anyway (any they get the pleasure of a year of treatment). All this for how many people that earlier treatment would have helped? Well, that is the point of the study.

    But the point is, that it's not the data that's bad, it's a system the encourages people to get knee jerk treatment.

  • by blair1q (305137) on Monday October 31, 2011 @03:08PM (#37898536) Journal

    Sure. If in your fantasy world nobody in government had any sort of ethics at all, and the government doesn't pass laws enforcing ethics standards.

    But here, in the real world, government workers are generally more ethical than private-sector businesses, and are bound by strict ethics regulations.

    So stop buying Fox News propaganda. The dysfunction of American healthcare is due to fractionation and greed in the system. Making it one system, with one set of standards and little opportunity for gouging people who are suffering, will make it far, far better. Not worse.

  • by Sponge Bath (413667) on Monday October 31, 2011 @03:40PM (#37899078)

    Dead people don't pay premiums.

    1. Healthy people pay premiums.
    2. Sick people pay premiums and collect benefits.
    3. Dead people pay no premiums and collect no benefits.

    The private insurance industry only wants #1. If you become #2, they will do everything in their power to help you progress to #3. There will always be a fresh supply of #1 (young/healthy) to replace "retired" customers.

    If this sounds cynical, it comes from personal experience with private health insurance and a talk with someone whose job with a private health insurer was to comb through records of people costing "too much" money and find any excuse to rescind a person's coverage. He was amazingly successful in helping customers reach #3.

  • Re:Blood tests (Score:3, Insightful)

    by njvack (646524) <njvack@wisc.edu> on Monday October 31, 2011 @03:46PM (#37899168)

    Presumably for the reasons enumerated in the summary. Too many costly, and quite frankly terrifying, false positives.

    More importantly, it's important that if you screen positive, the confirmatory tests and treatment yield a better outcome than doing nothing would have. Lots of people can point to a friend or relative for whom early detection treatment saved their life; however, if someone dies from the treatment of a cancer that would never have killed them, how will you ever know?

    Cancer is dangerous, but it's important to remember that cancer treatments are dangerous as well. People can and do die from complications from surgery and chemotherapy.

  • by nbauman (624611) on Monday October 31, 2011 @04:37PM (#37899890) Homepage Journal

    We could break apart the back room collective bargaining and price fixing and actually make health care something that people actually pay for, like car insurance and automotive services. That way, at least, we can see some competition for price and maybe people will even understand the resources they waste every time they go to the doctor about a cold. (Well, at least after they paid $80 to hear the doc say "It's a cold, drink some juice and get some rest" they'll think twice before doing it again.)

    This is a common fallacy -- that the costs of going to doctors for minor discretionary ailments are a significant part of health care costs. As the economist Paul Krugman has explained, the major expenses in health care aren't $80 visits to the doctor, but $50,000 and $100,000 cancers, $20,000 a year lifelong treatments for diabetes, $50,000 a year lifelong treatments for multiple sclerosis, $50,000 and $100,000 heart bypass operations.

    Actually, there have been many studies over at least 40 years to see whether charging patients more would produce better -- or even cheaper -- care. They all failed. Look up the Rand Health Insurance Experiment in Wikipedia. Patients who had greater copayments put off necessary care, like blood pressure medication (probably the most cost-efficient intervention we have).

    U.S. corporations like IBM tried imposing co-payments on their employees, and they ended those policies when they found that they wound up spending *more* money. Patients with asthma put off maintenance care, and wound up going to the hospital more.

    Health insurance isn't like car insurance. If your car is damaged, you know what the problem is and you know what's going on. If your doctor tells you that you have a disease you never heard of, and that you have to treat it right away, you don't know what's going on. It will take you more than a day of Google searches to find out.

    If a nurse tells you, "You should go to the hospital right away. It could be life-threatening," what are you going to do? Look it up on the Internet?

    Making health care decisions is like a graduate-level exam with questions you're unlikely to understand, and if you get one question wrong, you die.

    It would also help the problems with cancer screening: once people see a $10,000+ price tag on treating that maybe-dangerous tumor they'll definitely give waiting and seeing a thought.

    Ridiculous. The main thing a cancer patient wants to know is whether (or how long) he's going to live. The only concern about treating a tumor is (1) whether it really is a tumor that has to be treated and (2) what the best treatment is.

    Cancer chemotherapy causes heart failure and other cancers. Is the risk of death from treatment greater than the risk of death from no treatment? Nobody takes doxorubicin just because they can get it free.

    I know people who are doing watchful waiting, because their doctors think it's one of those false positives. I've talked about the decisions with them.

    $10,000 doesn't enter into the decision. How much is your life worth?

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