Times crafts strong reminder of screening’s dangers
Sarah-Kate Templeton, in The Times of London, tells the story of one victim of medical screening and overtreatment, wrapping that story in the larger debate about unnecessary medical screening and finally caps it all off with the news of a “Making Sense of Screening” guide, produced for the charity Sense About Science by a group of British scientists and doctors.
Templeton’s story provides a forceful reminder of the dangers of some early screening and aggressive treatment, all in the words of a 56-year-old math teacher who was diagnosed with a dormant form of breast cancer, and whose doctors recommended radical treatment.
The National Health Service has had to rewrite its advice to include warnings about potential harm caused by the screening process “after research showed that thousands of women have been misled into having unnecessary surgery.”
Cancer society’s messages on screening conflict
Filed under: Conflicts of interest, Hot Health Headline, Public health
The New York Times‘ Gina Kolata reports that the American Cancer Society, a longtime defender of early detection and cancer screening, is planning to release an online message next year “to emphasize that screening for breast and prostate cancer and certain other cancers can come with a real risk of overtreating many small cancers while missing cancers that are deadly.”
“We don’t want people to panic,” said Dr. Otis Brawley, chief medical officer of the cancer society. “But I’m admitting that American medicine has overpromised when it comes to screening. The advantages to screening have been exaggerated.”
The ACS’ change of heart on breast and prostate screening was inspired, in part, by a recent analysis published in JAMA.
In it, researchers report a 40 percent increase in breast cancer diagnoses and a near doubling of early stage cancers, but just a 10 percent decline in cancers that have spread beyond the breast to the lymph nodes or elsewhere in the body. With prostate cancer, the situation is similar, the researchers report.
In an interesting side note, Kolata includes a quote from Colin Begg, a biostatistician at Memorial Sloan-Kettering Cancer Center in New York, that shows a different perspective on media coverage of the screening debate.
“I am concerned that the complex view of a changing landscape will be distilled by the public into yet another ‘screening does not work’ headline,” Begg said. “The fact that population screening is no panacea does not mean that it is useless,” he added.
Kolata’s story was published on Tuesday. On Wednesday, the ACS released a statement from Brawley in which he says the organization stands by its screening recommendations. In the statement, Brawley says ACS “stands by its recommendation that women age 40 and over should receive annual mammography” and that its recommendation that men consult with their doctors to “make an informed decision about whether or not prostate cancer early detection testing is right for them. ”
The LA Times‘ Booster Shots blog has more, as does NPR’s health blog.
Business pushes screenings despite guidelines
Jeff Baillon, a reporter for KMSP-Minneapolis/St. Paul, saw Life Line’s ubiquitous mailers (here’s the one AHCJ’s Gary Schwitzer received) in which former Olympian Peggy Fleming urges people to go in for medical screening and decided to take a closer look at the company. Ohio-based Life Line sends a van to local neighborhoods and offers a variety of tests for a few hundred dollars.
Baillon and his crew, who went undercover for the occasion, found that the Life Line scans were so quick (as short as four minutes) that they wouldn’t yield good pictures, and would be more likely to turn up false positives and miss real problems. They also covered scans, like carotid artery scans, that guidelines generally advise against, and made no mention of government guidelines when scanning patients, even when prompted. For its part, Life Line, a for-profit business which screens about a million people every year and suggests tests even for low-risk groups, says they don’t “trick” customers and, in fact, actually help save lives.
Baillon’s piece:
Researcher: Screening could save young athletes
Writing for Time, Eben Harrell looks into whether athletes should be screened for cardiac problems in an effort to prevent sudden cardiac death (SCD). The condition, in which the heart suddenly stops working, is more likely to strike down athletes than it is their couch-potato counterparts.
There is evidence that screening, including the electrocardiogram, can prevent most cases of SCD.
Analyzing data from 42,000 athletes in the northeastern Veneto region of the country between 1979 and 2004, Italian researchers found that ECG screening resulted in an almost 90% drop in sudden cardiac deaths. Incidence of SCD among the unscreened non-athletic population did not change significantly during that time.
Noting the ECG’s shortcomings – it costs about $500 and produces false positives 7 percent of the time – Harrell adds that there is some evidence that a simple physical examination could be equally effective.
Related
Find tips about reporting on the health of student athletes and links to a number of articles, tip sheets, journal articles and other resources in AHCJ’s new “Reporting on sports injuries in school-age children” tip sheet.
Schwitzer: One-sided push for screening wrong
On his Schwitzer health news blog, University of Minnesota journalism professor, HealthNewsReview.org editor and AHCJ member Gary Schwitzer reminds journalists – in particular, CNN’s Howard Kurtz and Larry King – that even when you’re talking to prostate cancer survivors about screening for the disease, it’s “wrong to use a network television platform to give one-sided advice to an entire population of men without giving balancing information on harms.”
Reminding journalists that PSA screening might not always be a good thing, Schwitzer quotes the U.S. Preventative Services Task Force:
Potential harms from PSA screening include additional medical visits, adverse effects of prostate biopsies, anxiety, and overdiagnosis (the identification of prostate cancer that would never have caused symptoms in the patient’s lifetime, leading to unnecessary treatment and associated adverse effects). Much uncertainty surrounds which cases of prostate cancer require treatment and whether earlier detection leads to improvements in duration or quality of life.
Post documents self-referred, in-house scans
Filed under: Health care reform, Hot Health Headline
The Washington Post’s Shankar Vedantam explores the well-documented phenomenon in which physicians who own scanners are far, far more likely to order scans than those who don’t, and the lack of attention this extra screening is getting in the health care cost debate. The screening, Vendantam writes, has been shown to be unhelpful and perhaps even harmful.
Government panels have found that, across several areas of medicine, ordering more procedures does not improve health outcomes. In the case of medical scans, unnecessary imaging also creates a health risk — as many as 1 percent of all cancers in the United States appear to be caused by radiation from medical imaging, according to Amy Berrington de Gonzalez, a radiation epidemiologist at the National Cancer Institute.
Defenders of in-house screening argue that it increases speed and efficiency, though those assertions aren’t always borne out by national statistics. A 1992 law aimed to prevent a too-close relationship between physicians and the profits from screening devices has fallen prey to a loophole that technology has made it possible to exploit.
The issue was ostensibly settled in 1992 when the Stark Law was enacted. The legislation prohibited physicians from referring patients to the doctors’ own scanning devices. The law offered an exception, however, for physicians whose scanners were in the same office building as their practice. The exception was designed to allow doctors to keep small X-ray machines to quickly figure out, for example, whether a limping patient had a sprain or a fracture.
But since the law was passed, high-tech MRI and CT scanners have become smaller, making it possible for many more physicians to use the “in-office” exception.
As more expensive scans are being ordered more often, the percentage of income physicians earn from scanning has risen rapidly since 2000, Vendantam reports. For their part, physicians say that they are simply taking advantage of technology to provide better care.
President Obama has pledged that health care reform will include efforts to cut costs and some in Congress have seized upon limiting self referrals for scans as one way to bring costs down.
Congress, as part of health-care-reform efforts, is considering a proposal, championed by Reps. Jackie Speier (D-Calif.), Anthony Weiner (D-N.Y.) and Bruce Braley (D-Iowa), to prohibit the practice. Maryland is the only state that bans self-referrals, but the law is rarely enforced.
Organization: Teen breast tests wasteful, harmful
Jeff Baillon of KMSP in Minnesota’s Twin Cities reports that the National Breast Cancer Coalition (a nonprofit grassroots advocacy and fundraising organization) opposes Sen. Amy Klobuchar and Rep. Debbie Wasserman Schultz’s proposed education program pushing for breast cancer screening in girls as young as 15.
The coalition’s president called the bill a “waste of taxpayer dollars,” saying that it could actually “harm young women,” Baillon reported.
In the piece, oncologist Barry Kramer, who leads the Office of Disease Prevention at the National Institutes of Health, sayys there is no evidence that early screening is beneficial to young women, and some that it may even harm them through unnecessary biopsies that may then impede detection later in life when the risks are much higher.
Related
- Experts question early breast cancer screening push
- Cancer Screening: The Clash between Intuition and Science
Kramer, who spoke at Health Journalism 2008, made this presentation on the panel “Lies, damned lies and medical statistics: How to interpret the evidence” at Health Journalism 2008.
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Health Journalism 2010, AHCJ's annual conference, features a world-class program with story ideas, sources, stronger reporting skills, chances to meet newsmakers and network with other journalists.
- Health and education: Covering these intersecting beats
- Reporting on the business of health care
- Health reporting resources for journalists on state and local government beats
- Shortened Lives: How location, lifestyle affect health
- Covering a complex story for the long haul
- Aging in the 21st Century: Presentations and tip sheets
- AHCJ calls for better information from Joint Commission Web site
