Cancer Screening in Seniors Yields Few Benefits

Medpage Today ^ | Aug 18, 2014 | Charles Bankhead

[Innovative]

Screening older patients for cancer provided minimal benefit at considerable cost and increased use of invasive procedures, reported investigators in two separate studies.

"It is particularly important to question screening strategies for older persons," Gross continued. "Patients with a shorter life expectancy have less time to develop clinically significant cancers after a screening test and are more likely to die from noncancer health problems after a cancer diagnosis."

[steve86]

I guess I have to end my participation in the thread if the use of inferential statistics in medical research (my minor in grad school) is being summarily rejected. I don’t stick around anti-science threads in general.

[the OlLine Rebel]

Actually I think alot of this screening is a good way to guarantee income. Just as I think physicals (”wellness checks” in post-modern PC parlance) are a way to guarantee it. Meaning more expense every year and a way for insurance to get something, too.

I do not see why there is paranoia over this type of conclusion, when the same people usually eschew, rightfully, all the safety-NAZI precepts such as forcing everyone to wear belts and helmets.

[Yaelle]

“A consensus exists within the medical and scientific communities that routine cancer screening is unlikely to benefit people who have limited life expectancy. ...”

---

Unlikely to benefit the Utopian Socialist Society.

Surely it benefits the individual to know. And some cancers can be cured or at least lived with happily for a long time as with a chronic disease.

Each family needs to decide, post screening, whether invasive colon surgery is right for Pops when he is already feeble and frail.

But that is a different subject. They want to cut coverage for the elderly. People are living too long for obamaCare.

[Innovative]

“if the use of inferential statistics in medical research (my minor in grad school) is being summarily rejected.”

It isn’t “summarily rejected” — but I am sure you know too that depending on the data and how it’s analyzed and what is emphasized, erroneous or at least misleading conclusions can be drawn — as well as from overgeneralizations.

FDA shut down the genetic testing outfit “23 and me” which would have helped people identify or at least get an idea of their potential genetic disposition to certain diseases. If people would get such tests, it would help to have people focus on their more vulnerable potential diseases — THIS would be a scientific approach in my opinion.

But the objective here is NOT to heal people, but to save money at the expense of lives.

[Tired of Taxes]

Steve86, this thread isn’t “anti-science.”

For so many years, people were berated if they opted not to undergo screening. Now, ever since the ACA, all of a sudden, we’re being told there’s too much screening. The timing can’t be a coincidence. It’s not about science; it’s about politics.

[KarlInOhio]

I agree with this. Doctors wanted to schedule my 97 YO mother for a colonoscopy

That's surprising.

My dad was in his early 70s when he had is most recent colonoscopy and the doctor was iffy on whether he should get another one in five years. He did say that if dad did get one it would likely be his last if they didn't find anything because they were unlikely to treat for colon cancer when he gets into his eighties.

I want my doctor to discuss rational treatment options with me, not just look at Federal Health Form #298320B and say "I am not allowed to treat you. Sorry."

[The Great RJ]

Look at 5 year survival rates for breast cancer in the UK where "studies" like in the US said there was no statistical difference in starting mammograms at age 50 rather than 40 as in the US and doing them every two years compared to annually in the US. In the UK 5 years survival rate for breast cancer is 79% compared to 95% in the US. Determining what tests you should be taking and when should be up to you and your doctor, based on your medical and family history not on the recommendation of some government bean counters who never laid eyes on a patient.

My mother died of colon cancer, my sister died of ovarian cancer and my maternal grandmother had breast cancer. Given this added risk, my doctor and I have decided on colonoscopies every 5 years. I want an annual PSA test and if it is elevated consult with a urologist and my doctor to determine the risks and whether or not I should have further tests and what if any treatment I should choose. The idea of using stacks of statistics to determine your medical care is BS.

[ConorMacNessa]

I started having PSA'a, at the instance of my PCP, at age 50. Eight years later, in 2005, I had a PSA of 4.5 - no elevated PSA'a previous to that. A Prostate biopsy disclosed nothing of note. In September of 2007 I had another PSA at the same level and went for another Biopsy. I was diagnosed with Prostate Cancer with a Gleason of 9. Wages of Agent Orange.

I went to Hopkins for a second opinion at the instance of my Urologist - diagnosis confirmed. Traditional Radiation therapy 42X and Hormone therapy - Zolodex.

But for the second PSA, I'd be a dead man. I am greatly concerned at the recent noise I've heard on the news regarding calls for the PSA to be dropped as a routine test for men over 50. But for the PSA and the vigilance of my physicians, I would not have survived to see my daughter graduate from University or to see my 67th birthday, coming up in a few weeks.

May I have your your thoughts on the cost-benefit analysis of my having survived the last seven years?

America demands Justice for the Fallen of Benghazi!

O stranger, tell the Lacedaemonians that we lie here, obedient to their command.

Listen, O isles, unto me; and hearken, ye people, from far; The LORD hath called me from the womb; from the bowels of my mother hath he made mention of my name. (Isaiah 49:1 KJV)

[patriot08]

Commie sob. Seniors have as much right to live as any.

[steve86]

May I have your your thoughts on the cost-benefit analysis of my having survived the last seven years?

Sure, for you personally, great benefit vs. cost. That is an post hoc analysis. I suspect you couldn't have told me that was going to happen in 1997.

Absolutely meaningless for the population at large. If we could know before-the-fact who the "ConorMacNessas" are it would be great. Would avoid having to subject a lot of people to a dubious test that yields way too many false positives.

[steve86]

It’s not about science; it’s about politics.

Well, it is about cost to society to some extent; no argument there. Do you want to pay an additional $2,000/yr for everybody else's three-year colonoscopies? Most people don't.

In the above example, scheduling at 5 or 3 year intervals vs. ten year intervals subjects a whole bunch of people to unnecessary risks while barely even saving an additional life. If you still think 3 year intervals are desirable, then why not make it 3 month intervals and save another 1/16 life. You see, there's got to be a cutoff somewhere.

[ConorMacNessa]

So ex ante, if you were in charge of my health care, would you have given me the PSA at age 60? And, if not, why not? Is it that expensive that we need to relegate men who would have been diagnosed through its use to death by virtue of its non-use?

Lots of men over 50 develop prostate cancer, even without the spur of exposure to Agent Orange. What do you have to say to them?

America demands Justice for the Fallen of Benghazi!

O stranger, tell the Lacedaemonians that we lie here, obedient to their command.

Listen, O isles, unto me; and hearken, ye people, from far; The LORD hath called me from the womb; from the bowels of my mother hath he made mention of my name. (Isaiah 49:1 KJV)

[Innovative]

“I suspect you couldn’t have told me that was going to happen in 1997. “

That’s what the tests are for.

[Innovative]

“Well, it is about cost to society to some extent; no argument there. Do you want to pay an additional $2,000/yr for everybody else’s three-year colonoscopies? Most people don’t. “

You are making ridiculous assumptions — the whole point of insurance is exactly that some people will need extensive medical care, others may not, that’s how they establish — or at least used to — the premiums, so they are manageable for everyone.

But now that obamacare is expanding and the government is insuring many for free, the way to “make it work” is by not testing, not diagnosing people when their conditions may still be treatable, but wait until they are at death’s door, and then pronounce that it’s too late, it’s not worth treating them at that time, and let them die, preferably quickly.

[Intolerant in NJ]

No problem - actually Medicare, Medicaid and probably most third party payers have had requirements for decades that all care provided be “medically necessary” - hospitals and other providers have all sorts of policies and personnel dedicated to make sure that their documentation reflects this so that when outside inspectors from such organizations come around they can prove the appropriateness of care, else they don’t get paid, and maybe even get fined - hundreds of millions and probably billions spent yearly on paper work and reviews only vaguely related to actual patient care - my guess is that the money wasted on such empty efforts probably is more than would be spent on useless medical procedures if third parties stopped looking over the docs’ shoulders - so the no pay if not mandated part isn’t new - only the drive to make fewer and fewer procedures mandated......

[ConorMacNessa]

"Absolutely meaningless for the population at large. If we could know before-the-fact who the "ConorMacNessas" are it would be great. Would avoid having to subject a lot of people to a dubious test that yields way too many false positives."

A meaningless test? Do you have any concept of how painful it is to die from prostate cancer, or to have to endure surgery to remove a cancerous prostate?

A huge number of men over 50 suffer from prostate cancer - would you relegate our fathers, uncles and older brothers to that fate?

I have no idea how old you are, but if you're approaching your "Golden Years" - they may not turn out to be what you had in mind. Get a PSA, FRiend - the cost of foregoing it is higher than you think.

America demands Justice for the Fallen of Benghazi!

O stranger, tell the Lacedaemonians that we lie here, obedient to their command.

Listen, O isles, unto me; and hearken, ye people, from far; The LORD hath called me from the womb; from the bowels of my mother hath he made mention of my name. (Isaiah 49:1 KJV)

[bgill]

Next, the government will be asigning each of us our own personal iceberg the day we turn 60.

[Innovative]

“Next, the government will be asigning each of us our own personal iceberg the day we turn 60.”

There was that StarTrack episode, where people voluntarily marched into an incinerator when they turned 60 — it may come to pass.

[Tired of Taxes]

Just because a medical test is recommended doesn’t mean everyone will opt to have one. Often the deductible alone makes these medical tests unaffordable, plus sometimes people don’t trust certain medical procedures.

What I object to is the change in recommendations all of a sudden. The idea that, suddenly, these tests are no longer necessary just doesn’t ring true.

[LadyDoc]

I agree that some elderly don’t need routine screening, especially colonoscopy etc. In the past, we docs could use common sense. Then the lawyers came and sued us if we didn’t do everything, so costs went way up. Now the death panels will tell us what to do. Again no common sense.
Makes me glad I am retired.