For many years an approach to limiting disease burden has been widespread population screening followed by quick and intensive treatment for those with the disease. Cancer is typically addressed in this manner. A new article in the Journal of the American Medical Association examines experience with breast and prostate cancer screening and recommends changes in this standard approach. (JAMA Abstract) (Full article requires registration)
Breast and prostate cancer account for about 26% of cancer cases in the United States and screening for these cancers costs about $20 billion a year. 75% of men have had a PSA test and 70% of women have had a recent mammogram. The article points out that the result of all this screening has been identification of more tumors, more treatment of tumors, but paradoxically, little if any reduction in very serious cancer cases or in mortality.
The screenings are identifying many early stage tumors and these tend to be treated even though treatment may not be necessary for many of these cancers. Treatment contributes to rising health expenses, but also exposes patients to complications which may actually make their health worse. At the same time, the screenings are not identifying many aggressive cancers which are very threatening to a patient’s health. The reason appears to be that these serious tumors arise and grow so quickly that unless people were screened monthly or weekly, they might not be caught in an early stage.
The authors suggest that a better strategy might be to identify high-risk patients and screen only those patients, apply preventive measures to those patients, and when tumors are found, to develop biomarkers to determine which cancers are aggressive and need treatment. There is obviously a significant intersection with personalized medicine, because genetic screening of individuals can help determine how at risk they may be for certain cancers and there are already tests, with more in development, to profile specific tumors for aggressive characteristics.
This article is a useful reminder that some health strategies may not work out as originally planned and they need to be constantly reviewed for effectiveness. It is also another example of why some preventive measures, especially screenings, are not cost-effective. Vita Advisors has recently released a report on the Value of Prevention & Wellness which discusses the topic of financial and health outcomes for preventive and wellness measures. That research can be found under the publications tab of this site.