Tag Archives: unnecessary screening

KevinMD: Media is key to curbing MRI overuse

On the MedPage Today outlet KevinMD.com, Dr. Kevin Pho himself writes that media coverage of the overuse of certain screening procedures is “long overdue,” and praises The New York Timesrecent coverage of a study showing that in some cases MRIs can lead to more harm than good.

In the Times, reporter Gina Kolata explained, when unleashed upon the throwing shoulders of 31 healthy professional baseball pitchers, “M.R.I.’s found abnormal shoulder cartilage in 90 percent of them and abnormal rotator cuff tendons in 87 percent.” It’s a result, Kolata wrote, that shows that MRIs are “easily misinterpreted and can result in misdiagnoses leading to unnecessary or even harmful treatments.”

Back at his web portal, Pho writes that there are two steps that need to be taken to curb the overuse of the MRI. The first is cracking down on physicians who own their own MRI machines or otherwise profit from the tests, and the second is what he calls “adjusting patient expectations.” That’s where, he says, the media comes in.

there are some, but not all, patients who expect a scan and equate an MRI with “being thorough.” In fact, when orthopedic fellows cited in the Times story suggest that patients may not need a scan, patients “look at them like, ‘You don’t know what you’re doing.’”

Doctors can help educate patients away from the mythical benefits of overtesting. But the most effective teacher is the media, which wields significantly more influence. That’s why a story like this in the Times should be applauded, and promoted.

A fun aside? The study was conducted by none other than Dr. James Andrews, whose name will be familiar to anyone with even a passing familiarity with the sports pages.

Navratilova, GMA uncritically push screening

In February, Martina Navratilova was diagnosed with ductal carcinoma in situ, the most common form of breast cancer. She has since had a lumpectomy and says she’s doing well and doesn’t expect the cancer to return. But in an interview with Good Morning America during which she announced her diagnosis and surgery, the tennis star stepped beyond the world of sport and into the world of medicine. And there she made the sort of missteps she’s known for avoiding on the court.

“The reason I wanted to speak about this is to encourage these woman to have mammograms,” (Navratilova) said. “I just want to encourage women to have that yearly check-up.”

Navratilova said she doesn’t agree with recent recommendations that women between the ages of 40 and 49 should not necessarily get regular breast cancer screenings.

“The cancer knows that you’re not 50 yet?” she said. “I can’t speak for the doctors, but in my personal case I’m so glad that I did it.”

In her blog “A Healthy Piece of My Mind,” writer and PR rep Eve Harris pointed out the fallacies lurking in the tennis star’s screening recommendations, beyond the obvious age-related concerns.

First, Harris said, Navratilova exhorts women to scrape together the money to pay for screenings, yet doesn’t mention the many programs available to help uninsured and underinsured women pay for mammograms.

Second, Navratilova claims that she was lucky, and would have been in serious trouble had she not detected the cancer when she did. In fact, Harris writes, there is not enough information about the natural progression of such cancers to make that declaration.

GMA correspondent Robin Roberts, who also has battled breast cancer, failed to point out any of that and, in fact, offered a very simplified interpretation of what the new breast cancer screening recommendations say.

(Hat tip to @lauranewmanny)

Times crafts strong reminder of screening’s dangers

Sarah-Kate Templeton, in The Times of London, tells the story of one victim of medical screening and overtreatment, wrapping that story in the larger debate about unnecessary medical screening and finally caps it all off with the news of a “Making Sense of Screening” guide, produced for the charity Sense About Science by a group of British scientists and doctors.

Templeton’s story provides a forceful reminder of the dangers of some early screening and aggressive treatment, all in the words of a 56-year-old math teacher who was diagnosed with a dormant form of breast cancer, and whose doctors recommended radical treatment.

The National Health Service has had to rewrite its advice to include warnings about potential harm caused by the screening process “after research showed that thousands of women have been misled into having unnecessary surgery.”

(Hat tip to Gary Schwitzer)

Cancer society’s messages on screening conflict

The New York Times‘ Gina Kolata reports that the American Cancer Society, a longtime defender of early detection and cancer screening, is planning to release an online message next year “to emphasize that screening for breast and prostate cancer and certain other cancers can come with a real risk of overtreating many small cancers while missing cancers that are deadly.”

MRI entrance, photo by Scott & White Healthcare via Flickr.

“We don’t want people to panic,” said Dr. Otis Brawley, chief medical officer of the cancer society. “But I’m admitting that American medicine has overpromised when it comes to screening. The advantages to screening have been exaggerated.”

The ACS’ change of heart on breast and prostate screening was inspired, in part, by a recent analysis published in JAMA.

In it, researchers report a 40 percent increase in breast cancer diagnoses and a near doubling of early stage cancers, but just a 10 percent decline in cancers that have spread beyond the breast to the lymph nodes or elsewhere in the body. With prostate cancer, the situation is similar, the researchers report.

In an interesting side note, Kolata includes a quote from Colin Begg, a biostatistician at Memorial Sloan-Kettering Cancer Center in New York, that shows a different perspective on media coverage of the screening debate.

“I am concerned that the complex view of a changing landscape will be distilled by the public into yet another ‘screening does not work’ headline,” Begg said. “The fact that population screening is no panacea does not mean that it is useless,” he added.

Kolata’s story was published on Tuesday. On Wednesday, the ACS released a statement from Brawley in which he says the organization stands by its screening recommendations. In the statement, Brawley says ACS “stands by its recommendation that women age 40 and over should receive annual mammography” and that its recommendation that men consult with their doctors to “make an informed decision about whether or not prostate cancer early detection testing is right for them. ”

The LA Times‘ Booster Shots blog has more, as does NPR’s health blog.

Business pushes screenings despite guidelines

Jeff Baillon, a reporter for KMSP-Minneapolis/St. Paul, saw Life Line’s ubiquitous mailers (here’s the one AHCJ’s Gary Schwitzer received) in which former Olympian Peggy Fleming urges people to go in for medical screening and decided to take a closer look at the company. Ohio-based Life Line sends a van to local neighborhoods and offers a variety of tests for a few hundred dollars.

Baillon and his crew, who went undercover for the occasion, found that the Life Line scans were so quick (as short as four minutes) that they wouldn’t yield good pictures, and would be more likely to turn up false positives and miss real problems. They also covered scans, like carotid artery scans, that guidelines generally advise against, and made no mention of government guidelines when scanning patients, even when prompted. For its part, Life Line, a for-profit business which screens about a million people every year and suggests tests even for low-risk groups, says they don’t “trick” customers and, in fact, actually help save lives.

Baillon’s piece:

(Hat tip to Gary Schwitzer)