Over-screening skews disease research and puts harsh burdens on seniors

medtest-300x169Medical over-screening and over-testing not only adds hundreds of billions of dollars in unnecessary costs to U.S. health care, it also may be skewing researchers’ understanding of what causes disease and imposing harsh burdens on older Americans.

Stat, an online health and medical news service, has highlighted an intriguing study from the Dartmouth Institute for Health Policy and Clinical Practice, whose researchers are well-respected for their work on their Atlas Project, which “documents glaring variations in how medical resources are distributed and used in the United States.”

Dartmouth researchers recently examined screening, especially for breast, prostate, and thyroid cancers, and found that over-testing, as Stat reported, may be “misleading doctors and the public about what increases people’s risk of developing cancers,” especially “the types of cancer that matter.”

Certain types of cancers, the experts noted, are “scrutiny dependent.” The more doctors look for them, the more cases they find of them — and it also turns out that more of the instances they discover turn out to be relatively harmless. This has been shown in nations like South Korea, where zealous screening for thyroid cancer has resulted in a “false epidemic” of the disease.

As Dr. H. Gilbert Welch, a Dartmouth Institute scholar and co-author of the study published in the Annals of Internal Medicine, told Stat about over-screening for scrutiny-dependent disease: “Detecting cancers that would never become apparent is screwing up our understanding of risk factors.”

Part of the concern is economic and familial: Men take the common PSA test for prostate cancer, partly because they have friends or family who do so. Women undergo breast cancer tests for the same reason — and those who live in disproportionately wealthy areas do so at very high rates.

But just because better informed and richer men and women get screened more often for prostate and breast cancer do their results mislead researchers about those diseases and the factors that may make them more lethal? Over-screening also means that many patients go on to undergo further, expensive, uncomfortable, and painful testing. It also results in many learning the exams were unnecessary. Many more cases of relatively harmless disease are discovered, and doctors, with patients, decide no further treatment is needed.

Meantime, when experts are looking at data generated by these groups, are they missing cancer causes in poorer, communities of color? The data show that prostate cancer runs in families, the members of which often take the PSA test and create a self-confirming record. But the disease hits blacks and Hispanics hard, with some research suggesting that diet and poverty are key factors. Black and Hispanic women have slightly lower breast cancer rates but African American women more often have more serious types of tumors.

The Dartmouth researchers have suggested that medical experts focus less on risk factors of developing certain cancers —which “determines and reflects patients who get tested” — and more on factors that lead to cancer deaths. Which types of breast, prostate, and thyroid cancer are most likely to kill patients with them?

To be sure, cancer screening and prevention measures — most emphatically getting Americans to stop smoking or, better, never take up tobacco — have played their part in the nation’s continued and important decline in the disease’s death rate.

As the Washington Post reported of a new American Cancer Society study, that death rate “declined 1.7 percent in 2015, the latest indication of steady, long-term progress against the disease …. Over nearly a quarter-century, the mortality rate has fallen 26 percent, resulting in almost 2.4 million fewer deaths than if peak rates had continued. But the report [also] shows that Americans’ No. 2 killer remains a formidable, sometimes implacable, foe. An estimated 609,000 people are expected to die of the ailment this year, while 1.74 million will be diagnosed with it.”

And though cancer may seem like a disease to be detected and battled at any age, experts question whether excessive screening and treatment imposes unnecessary, heavy burdens on seniors. Consumer Reports has collected a list of costly, invasive tests and procedures that older adults and their families and friends may want to think a lot about before letting seniors undergo them. The independent, nonprofit Kaiser Health News Service has put up a grim story about how elderly patients suffer more than they benefit from “excessive screening.”Besides being subjected to painful, invasive tests, they may even then be forced to undergo major follow-up procedures that slash at their already limited lives.

In my practice, I see the major harms that patients suffer while seeking medical services, as well as their heart-breaking struggles to access and afford quality medical care. Americans spend more than $3 trillion annually on health care, and the nation can’t afford unnecessary screens and tests — especially when they’re detrimental to patients, especially the elderly, and if they undercut our capacity to determine diseases’ causes to treat them better.

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