Medicine
Recently, I attended a conference that included an exercise where attendees were asked how many patients they thought it was acceptable to diagnose and treat needlessly (or "overtreat") in order to prevent one death from cancer. We stood at various points along a wall that represented different thresholds: at one end, 100 persons overtreated for every 1 life saved; at the other, 1 person overtreated for every 1 life saved. Not surprisingly, attendees held a wide range of opinions (I stood somewhere in the middle), but the exercise illustrated the tradeoff inherent in effective screening tests for breast, colorectal, and cervical cancer: for every person who benefits from screening, others will be harmed. This fact has led many physicians to advocate that shared decision-making be used more widely to integrate patients' preferences and values with the decision to accept or decline a screening test.
How often do physicians take the time to explain the harms of cancer screening to their patients? A research letter published in JAMA Internal Medicine explored this question in an online survey of 317 U.S. adults between 50 and 69 years of age. 83 percent of participants had attended at least 1 routine cancer screening; 27 percent had undergone 3 or more. However, less than 10 percent of participants had ever been informed by their physicians of the risk that the screening test(s) could lead to overdiagnosis and overtreatment. The few physicians who did attempt to quantify this risk generally provided information that was inconsistent with the medical literature.
If the results of this survey are representative of the practices of U.S. primary care clinicians, then more than 90 percent aren't telling patients that there are downsides to undergoing routine mammograms, colonoscopies, and Pap smears. Why not? Is it because they aren't familiar enough with the data to accurately describe these harms? Or is it because they fear that patients who receive information about cancer screening harms will choose to decline these tests?
**
This post originally appeared on the AFP Community Blog.
- The Top Ten Common Sense Posts Of 2013 (yes, You Read That Right)
You know how Facebook periodically offers you a #TBT photo of a memory that you posted two or more years ago? Well, while I continue working on another top 10 list (of my favorite population health and health care books of 2015), here are links to and...
- Lung Cancer Screening: Understanding "relative Risk"
Enthusiasm for lung cancer screening has never been higher, following publication of the National Lung Screening Trial (NLST) report that heavy smokers who underwent 3 rounds of low-dose computed tomography (CT) screening were 20 percent less...
- The Top Ten Common Sense Posts Of 2013
The past year has been a productive one for me professionally. I became an Associate Professor at Georgetown, completed my Master of Public Health degree, made national television and radio appearances to discuss lung cancer screening on NBC News and...
- Lung Cancer Screening: Understanding "relative Risk"
Enthusiasm for lung cancer screening has never been higher, following last year's report from the National Lung Screening Trial (NLST) that heavy smokers who underwent 3 rounds of low-dose computed tomography (CT) screening were 20...
- Challenging Conventional Clinical Wisdom
Over the past few years, I've been invited to speak twice at Lancaster General Hospital (PA) about studies of the effects of screening for colorectal and prostate cancer. Recognizing the need to further explore the controversies surrounding the evidence...
Medicine
Why don't clinicians discuss cancer screening harms?
Recently, I attended a conference that included an exercise where attendees were asked how many patients they thought it was acceptable to diagnose and treat needlessly (or "overtreat") in order to prevent one death from cancer. We stood at various points along a wall that represented different thresholds: at one end, 100 persons overtreated for every 1 life saved; at the other, 1 person overtreated for every 1 life saved. Not surprisingly, attendees held a wide range of opinions (I stood somewhere in the middle), but the exercise illustrated the tradeoff inherent in effective screening tests for breast, colorectal, and cervical cancer: for every person who benefits from screening, others will be harmed. This fact has led many physicians to advocate that shared decision-making be used more widely to integrate patients' preferences and values with the decision to accept or decline a screening test.
How often do physicians take the time to explain the harms of cancer screening to their patients? A research letter published in JAMA Internal Medicine explored this question in an online survey of 317 U.S. adults between 50 and 69 years of age. 83 percent of participants had attended at least 1 routine cancer screening; 27 percent had undergone 3 or more. However, less than 10 percent of participants had ever been informed by their physicians of the risk that the screening test(s) could lead to overdiagnosis and overtreatment. The few physicians who did attempt to quantify this risk generally provided information that was inconsistent with the medical literature.
If the results of this survey are representative of the practices of U.S. primary care clinicians, then more than 90 percent aren't telling patients that there are downsides to undergoing routine mammograms, colonoscopies, and Pap smears. Why not? Is it because they aren't familiar enough with the data to accurately describe these harms? Or is it because they fear that patients who receive information about cancer screening harms will choose to decline these tests?
**
This post originally appeared on the AFP Community Blog.
- The Top Ten Common Sense Posts Of 2013 (yes, You Read That Right)
You know how Facebook periodically offers you a #TBT photo of a memory that you posted two or more years ago? Well, while I continue working on another top 10 list (of my favorite population health and health care books of 2015), here are links to and...
- Lung Cancer Screening: Understanding "relative Risk"
Enthusiasm for lung cancer screening has never been higher, following publication of the National Lung Screening Trial (NLST) report that heavy smokers who underwent 3 rounds of low-dose computed tomography (CT) screening were 20 percent less...
- The Top Ten Common Sense Posts Of 2013
The past year has been a productive one for me professionally. I became an Associate Professor at Georgetown, completed my Master of Public Health degree, made national television and radio appearances to discuss lung cancer screening on NBC News and...
- Lung Cancer Screening: Understanding "relative Risk"
Enthusiasm for lung cancer screening has never been higher, following last year's report from the National Lung Screening Trial (NLST) that heavy smokers who underwent 3 rounds of low-dose computed tomography (CT) screening were 20...
- Challenging Conventional Clinical Wisdom
Over the past few years, I've been invited to speak twice at Lancaster General Hospital (PA) about studies of the effects of screening for colorectal and prostate cancer. Recognizing the need to further explore the controversies surrounding the evidence...