October 31, 2011
EARLY CANCER DETECTION: Suddenly, it’s not good for you after all. “Now expert groups are proposing less screening for prostate, breast and cervical cancer and have emphasized that screening comes with harms as well as benefits. . . . What changed? . . . Is all this happening now because of worries over costs?”
UPDATE: Reader David Lange writes:
I am probably one of the people the recent articles on prostate cancer screening is attempting to influence. I’ve been tracking my PSA since I was fifty and I am now fifty-nine. Having survived a type of leukemia in the 90s, I am convinced that early detection dramatically increases the chances of long term survival. My PSA jumped from 1.6 to 2.0 in one year and from 2.0 to 2.9 the next. My oncologist recommended a two month follow-up and it remained stable. Six months later, it rose to 3.2 and although my German urologist advised me to retest in six months, my NJ based oncologist was concerned about the velocity of the increase and recommended a biopsy, which came back positive with a small amount of low-risk cancer. I am now traveling to Johns Hopkins for seed implants, but suspect I would fall into the group that would never have been biopsied with the low PSA I have. On my last PSA test, it dropped back to 2.7. Ultimately, it is my decision whether to pursue treatment, but so far, I have not met one patient or doctor who would recommend doing nothing. Until they develop a test that can determine which cancers become agressive and which will not, on an individual rather than a statistical basis, it makes sense to do something.
Many people are concerned that the new “science” that has led to a sudden about-face on testing, coincident with the passage of ObamaCare, is driven by costs rather than patient welfare. This may be unfair, but one of the hazards of politicizing the health care system is that suspicions of, well, politicization of the health care system become unavoidable.
ANOTHER UPDATE: Suspicious reader Fran Akridge notes: “Not detecting cancer early has financial benefits for both the Medicare (too late for anything except hospice) and Social Security (earlier death) pools.”