There is no doubt that screening and early detection of cancer has played a key role in the significant decrease in cancer deaths in the U.S. over the past two decades. So why are some oncologists now recommending less screening?
Dr. Steven Kalter of San Antonio's START Center for Cancer Care says there is a new concern about 'overdiagnosis' of cancer, especially too much cancer screening of patients who are in the seventies and eighties
.He says providing screening to many elderly patients is expensive, and can, in many cases, do more harm than good.
"After a number of negative mammograms, patients in their seventies and eighties, it is almost more risky to request the patient to through a mammography than it is beneficial," Dr. Kalter said.
The American Journal of Public Health reports that one in five women with 'severe cognitive impairment' like Alzheimer's Disease, are still receiving regular mammograms. Dr. Kalter says that testing itself could harm the delicate patient, and if tumors are found, the 'harm will outweigh the benefits.'
He says family doctors, who know patients better than specialists, have to start making very critical decisions about who should, and who should not, undergo cancer screening.
"I think that we have to ask, is this patient likely to live for another ten to twenty years, and if the answer is no, then testing may not be in their best interest."
The problem is that, with the success of cancer screening, the entire system is set up to encourage patients to get tested. Insurance companies often provide financial incentives to physicians who refer their patients for cancer screening, and doctors are also concerned that they could be sued by patients they decide not to refer for screening, but then are diagnosed with cancer.
"Often times in the elderly, cancers grow more slowly," he said. "Tanking a 'one size fits all' concept is just not appropriate, particularly for the elderly."
He says in many cases, an older patient will 'die with cancer and not die from cancer.'
A recent study of patients on Medicare revealed that as many as 10% of patients who have stage four cancer are actually receiving screenings for other cancers. even though they will clearly die from the primary cancer they are suffering from well before any newly discovered tumors have a chance to grow.
There is also concerns about the costs of 'overscreening.' A study in 'Health Affairs' reveals that cancer screening is one of the procedures most overprescribed by doctors.