A recent trend is moving toward fewer screening tests, which can sometimes do more harm than good.
Updated: July 15, 2012 11:16AM
Many men were surprised when a government advisory panel recommended that doctors stop using the PSA test to screen healthy men for prostate cancer.
Yet health experts say last week’s recommendations by the U.S. Preventive Services Task Force are a part of a broader trend that has been building for years. People are taking a closer look not just at cancer screenings but at all medical tests and procedures, says Steven Woloshin, co-director of the Center for Medicine and the Media at the Dartmouth Institute for Health Policy and Clinical Practice. Concern about “overtesting” and “overtreating” patients is growing because of a rising recognition that these interventions often have risks and serious side effects.
“There is some sort of shift, and it’s encouraging,” Woloshin says. “It feels like this is the beginning of a sea change in attitudes towards testing, treating and overdiagnosis.”
Last month, nine physicians’ groups launched the “Choosing Wisely” campaign to discourage 45 frequently overused tests and procedures.
Many such tests involve trying to “help the well stay well by looking for things to be wrong,” says H. Gilbert Welch, a physician and co-author of Overdiagnosed: Making People Sick in the Pursuit of Health, written with Woloshin and Lisa Schwartz, the other co-director of the Center for Medicine and the Media.
The American College of Radiology also is leading campaigns called Image Wisely, to reduce unnecessary radiation exposure in adults, and Image Gently, to reduce exposure in children.
† In 2008, before the task force voted against the PSA entirely, it recommended offering it only to men under age 75, reasoning that older men probably would not be helped by a test that largely detects slow-growing cancers.
† In 2009, the task force recommended against routine mammograms for women under 50 and suggested women over 50 be screened every other year instead of annually. That recommendation drew fierce protests from women, radiologists and many politicians.
† In March, in a less controversial move, the American Cancer Society revised its cervical cancer recommendations, suggesting that women be screened every three years, instead of every year, between the ages of 21 and 29. Older women can wait five years between tests and stop screening at age 65 .
† Last week, medical groups endorsed using CT scans to screen for lung cancer, but only in a very specific group: smokers and ex-smokers ages 55 to 74 who smoked a pack a day for 30 years, and who still smoke or quit within the past 15 years. The PSA was approved in 1986 to monitor patients with diagnosed prostate cancer, and in 1994 to screen healthy men — before researchers had determined whether the tests improved survival.
“The PSA test was unleashed on the male population without any evidence that it provides any benefit ,” Bach says. “We didn’t realize we would cause thousands of men to become impotent.”
Yet convincing people that they could be better off with fewer screenings could be a tough sell, says Virginia Moyer, chair of the U.S. Preventive Services Task Forc . Public health groups spent decades persuading reluctant men to give blood samples for PSA tests and frightened women to get their breasts compressed by mammography machines. But Welch agrees the tide is turning. There’s a growing recognition that “when you are dealing with well people, the balance is really fine: It’s hard to make a well person better, but it isn’t hard to make them worse,” Welch says.
Gannett News Service