Then, the American Society for Radiation Oncology (ASRO), a body which writes medical guidelines, told doctors not to begin radiation on women over the age of 50 and with a small cancer that had not yet spread, without first considering the shorter therapy. In 2012, ASRO told physicians not to conduct tumor marker tests and scans such as CT, PET and bone scans for survivors of early breast cancer.
In addition, according to an exclusive analysis for nonprofit health newsroom, Kaiser Health News—which was completed by eviCore healthcare—only 48% of patients were offered this (shorter) treatment course in 2017.
For survivors of early breast cancer with no signs of relapse “these tests aren’t helpful and can be hurtful,” said Dr Gary Lyman, a breast cancer oncologist and health economist at the Fred Hutchinson Cancer Research Centre. But, why are they so harmful?
They can cause patients more harm than goodOverzealous screening and treatment for cancer can put patients through unnecessary pain and suffering. Many doctors over-screen elderly patients for cancers of the thyroid, breast, prostate and skin, causing them to undergo treatments that are unlikely to extend their lives.
A study conducted by researchers at the University of California, San Francisco, in 2009 and led by Dr Rebecca Smith-Bindman, found that the radiation doses from common CT scans used in clinical diagnostics are higher than people know.
In fact, the study found – for 20-year-old patients – the risk of developing cancer from a CT coronary angiography is twice as likely as that of 40-year old women (one in 270). The National Cancer Institute in the US estimates that 2% of all cancers in the country are caused by medical imaging.
Aside from exposure to carcinogens, even simple yet repeated blood tests can take their toll on patients. Meg Reeves, a 60-year old breast cancer survivor, said that repeated needle sticks, especially from unnecessary annual blood tests, have left severe scarring on the veins in her left arm.
This problem is accentuated by the fact that nurses cannot take blood from her right arm as she had breast surgery on her right side and injuring the arm could lead to lymphedema. Following Reeves' treatment, she was also given yearly MRI scans using the dye gadolinium, which is currently under investigation by the US Food and Drug Administration (FDA) for leaving metal deposits in the brain.
They are expensiveIn many parts of the world, where healthcare is not offered free of cost by the government, prolonged treatment for cancer can also be financially debilitating for the patient. A 2014 study by Dr Justin Bekelman, associate professor of radiation oncology at the University of Pennsylvania Perelman School of Medicine, found that women who were treated for longer faced nearly USD2,900 more in medical costs in the year after diagnosis.
Reeves, for example, said she had to sell her house to pay her hospital bills even though she had health insurance from her employer. “It was financially devastating,” she lamented. “It’s the worst kind of financial toxicity, because you’re incurring costs for something with no benefit,” expressed Dr Scott Ramsey, director of the Hutchinson Institute for Cancer Outcomes Research.
A study conducted by Dr Gary Lyman, a breast cancer oncologist and health economist at the Fred Hutchinson Cancer Research Centre – which was also published in the Journal of Clinical Oncology – found found that women who were monitored with biomarkers had to pay an additional USD6,000. Patients also find it costly, logistically. For those who live in rural areas, multiple trips to hospitals to seek long drawn out treatments are arduous. Rural breast cancer patients are more likely than urban women to choose a mastectomy, as it does not need follow-up radiation.
They hurt the healthcare industryAccording to a 2009 report by the National Academy of Medicine in America, unnecessary medical services cost the health care system USD120 billion a year. Many doctors have blamed their usage of extraneous treatments on the financial incentives they are rewarded.
Many insurers, for example, pay physicians for each radiation session; therefore, prescribing longer treatments is in the doctor’s best financial interest. Karuna Jaggar, executive director of Breast Cancer Action, an advocacy group says, “it’s an example of how our profit-driven health system puts financial interests above women’s health and well-being.” According to According to Dr Justin Bekelman, associate professor of radiation oncology at the University of Pennsylvania Perelman School of Medicine, “the data reflect how hard it is to change practice.”
Why is this – what can be done to help?“Patients used to feel like ‘more is better’,” expressed Daniel Wolfson, executive vice president of the American Board of Internal Medicine Foundation (ABIM). “But sometimes less is more. Changing that mindset is a major victory.”
As echoed by Dr Bruce Landon, a professor of health care policy at Harvard Medical School, “We tend in the health care system to be pretty slow in abandoning technology.” He said, “People say, ‘I’ve always treated it this way throughout my career. Why should I stop now?’” Many other doctors are afraid of being sued for having done too little.
In his paper, Dr Lyman suggests targeting oncologists “to improve appropriate tumour marker testing.” The Choosing Wisely campaign, which began in 2012 by the ABIM, works to raise awareness among patients. Ultimately, breast cancer survivor Annie Dennison expresses that, “patients need to be able to say, ‘I’d like to do it this way because it’s my body.’” MIMS
[Editor’s note: The original story by Liz Szabo is available on Kaiser Health News.]
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