Can screenings be too much of a good thing?

Medicare reimburses for cancer and other screenings as part of routine care for older adults. Of course, the goal is to catch diseases in their earliest, most treatable stages. But can preventive care become too much of a good thing?

For years, evidence has grown about wasted Medicare dollars on needless screenings. The Center for Public Integrity found that 40 percent of Medicare spending on common cancer screenings are unnecessary – costing billions of taxpayer dollars.

Yet despite this news, Medicare continues to reimburse for many common tests like PSA and screenings for breast cancer – as well as MRIs, and CT scans in older adults that are not medically necessary, or sometimes, even appropriate.

Atul Gawande reports in this New Yorker article about the many tests that are wasteful, irrelevant for the patient’s condition, or detect cancers so tiny that they will never develop into a more serious form of the disease. Women over age 75 are still routinely screened for breast cancer, in spite of indications (and U.S. Preventive Services Task Force recommendations) that there is no conclusive evidence on about the efficacy of mammograms in that population. The costs of Medicare-funded breast cancer soared over a 10-year period but did not lead to an increase in early detection, according to a study from Yale University. This U.S. News & World Report story tries to explain why old practices die hard.

Alan Cassels, a writer and drug policy researcher affiliated with the School of Health Information Sciences at the University of Victoria, has developed this comprehensive tip sheet that explores issues of unnecessary cancer screenings, and in particular, breast cancer screenings, in older adult women. Any journalist looking into this issue should check out the facts and figures he puts in context, as well as some terrific story ideas and resources. See the tip sheet.

(Note: This post was edited to more accurately reflect Cassels’ job and affiliation.)

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