Better not to Know
Well, it is certainly counterintuitive. A government panel recommended last week most men no longer be tested for elevated PSA (Prostate Specific Antigen) levels in their annual physicals. The same panel recommended two years ago most women in their forties and fifties not have annual mammograms. They reason the tests don’t save many lives, create unnecessary anxiety, and often lead to over diagnosis and inappropriate treatments. With all the angry debate about pulling the plug on Grandma in the lead up to passage of the Affordable Care Act (Obamacare if you prefer) it’s worth a little discussion on this panel and their recommendations.
The US Preventative Services Task Force is not a product of the ACA, it does not set government policy, and its members are not federal employees. It was created by congress in 1984 to review scientific evidence on the efficacy of various preventive medicine measures and make recommendations to the health care community. Anybody can nominate a member. You can nominate yourself. There are sixteen current members serving four year terms. I count thirteen MDs, two nurses, and one public health PhD who is neither a nurse nor a physician. Most are academics.
Over the years the panel has issued recommendations on screening and preventive measures for everything from hearing loss to scoliosis. The Department of Health and Human Services uses these recommendations in formulating implementing regulations for ACA, so they are relevant to Obamacare. DHHS doesn’t use the revised standard for breast cancer screening issued two years ago. They use an earlier standard issued in 2002 which recommends mammograms every 1-2 years for women over 40. No word on whether DHHS will adopt the new recommendations for PSA testing.
The new panel logic goes something like this. If you get back test results suggesting you might have cancer you may have an overanxious reaction. You might want more testing when there is no need to worry. This is where the panel logic breaks down. Of course you would want more testing. When a spot showed up on my CAT scan last year I went to see an oncologist about it. She compared it to an earlier scan and didn’t see anything to indicate cancer. I regularly send her a copy of my blood work and that’s it. I don’t even talk to her about it. She will let me know if there is anything new.
But three years ago a spot also showed up on a scan for my wife. Her surgeon recommended a biopsy and that’s what we did. The panel seems to be saying the biopsy might have been negative and it would have been better to let it alone. No scan, no spot, no biopsy, probably no harm. But the biopsy showed cancer. The surgeon recommended removing a swollen lymph node and some surrounding tissue. Two oncologists agreed so we did the surgery. We never actually found a cancerous tumor. There is a possibility we were seeing residue from a cancer that was no longer active. Nevertheless, the oncologists recommended chemotherapy and radiation so we did that too.
If we hadn’t done the original scan I don’t know when we would have found the cancer. Maybe never, never had that terrible sinking feeling when we first thought she might have cancer, never been so frightened as when we knew it was cancer, never had to go through that awful chemotherapy. But what if we hadn’t? She had stage two cancer. What if we had waited until it progressed to stage three or four? What then?
The panel seems to have the numbers right. A lot of people are overreacting to scary test results. But stop doing the tests? Not me. I would rather know.
The US Preventative Services Task Force is not a product of the ACA, it does not set government policy, and its members are not federal employees. It was created by congress in 1984 to review scientific evidence on the efficacy of various preventive medicine measures and make recommendations to the health care community. Anybody can nominate a member. You can nominate yourself. There are sixteen current members serving four year terms. I count thirteen MDs, two nurses, and one public health PhD who is neither a nurse nor a physician. Most are academics.
Over the years the panel has issued recommendations on screening and preventive measures for everything from hearing loss to scoliosis. The Department of Health and Human Services uses these recommendations in formulating implementing regulations for ACA, so they are relevant to Obamacare. DHHS doesn’t use the revised standard for breast cancer screening issued two years ago. They use an earlier standard issued in 2002 which recommends mammograms every 1-2 years for women over 40. No word on whether DHHS will adopt the new recommendations for PSA testing.
The new panel logic goes something like this. If you get back test results suggesting you might have cancer you may have an overanxious reaction. You might want more testing when there is no need to worry. This is where the panel logic breaks down. Of course you would want more testing. When a spot showed up on my CAT scan last year I went to see an oncologist about it. She compared it to an earlier scan and didn’t see anything to indicate cancer. I regularly send her a copy of my blood work and that’s it. I don’t even talk to her about it. She will let me know if there is anything new.
But three years ago a spot also showed up on a scan for my wife. Her surgeon recommended a biopsy and that’s what we did. The panel seems to be saying the biopsy might have been negative and it would have been better to let it alone. No scan, no spot, no biopsy, probably no harm. But the biopsy showed cancer. The surgeon recommended removing a swollen lymph node and some surrounding tissue. Two oncologists agreed so we did the surgery. We never actually found a cancerous tumor. There is a possibility we were seeing residue from a cancer that was no longer active. Nevertheless, the oncologists recommended chemotherapy and radiation so we did that too.
If we hadn’t done the original scan I don’t know when we would have found the cancer. Maybe never, never had that terrible sinking feeling when we first thought she might have cancer, never been so frightened as when we knew it was cancer, never had to go through that awful chemotherapy. But what if we hadn’t? She had stage two cancer. What if we had waited until it progressed to stage three or four? What then?
The panel seems to have the numbers right. A lot of people are overreacting to scary test results. But stop doing the tests? Not me. I would rather know.
Labels: Cancer, Prostate Cancer, PSA Testing
posted by Onfoot at 5:43 AM
0 Comments:
Post a Comment
<< Home