Tim Trysla, Executive Director
On Behalf of the Access to Medical Imaging Coalition
The arguments put forth in this article do a disservice to patients and send detrimental mixed messages on the value of early diagnosis ??? not only for breast cancer, but for all cancers and other diseases where early detection is critical. Begley???s thesis rests on insufficient data, and quite honestly, while it tries to build upon statements from the American Cancer Society (ACS), it???s important to note that the ACS quickly distanced itself from comments proffered by its chief medical officer Dr. Brawley, saying that: "Mammography is effective -- mammograms work and women should continue get them... The American Cancer Society stands by its recommendation that women age 40 and over should receive annual mammography, and women at high risk should talk with their doctors about when screening should begin based on their family history."
Patient advocacy organizations know that cancer screenings and early disease detection save lives. Citing National Cancer Institute and American Cancer Society data, the Canary Foundation recently wrote (http://www.canaryfoundation.org/docs/PressKit/EarlyDetectionFactSheet09.pdf): ???Early detection is key in breast and prostate cancers. Five-year survival for breast- and prostate-cancer patients with early stage disease is 98% and 100%, respectively, and survival rates remain high at 10 years.???
What is the import of these statistics in the current health reform debate? When policymakers propose, as some do now, making drastic reimbursement cuts to advanced imaging, such as CT, MR, and PET, as well as imposing a severe tax on imaging equipment, it affects routine screenings such as mammography and DEXA ??? a bone-density test for osteoporosis. A study by the Moran Company shows that after the Deficit Reduction Act of 2005 cut Medicare spending for advanced imaging by 19.2 percent, growth of mammography use and spending for Medicare patients declined. The report also showed that spending for DEXA declined by 40 percent and use shrank by .2 percent.
Because proposals to cut reimbursements for advanced imaging will ultimately have negative repercussions for all screening tests, patients and patient advocates representing virtually all disease states have serious concerns. That???s why nearly thirty patient advocacy groups have written Congress and the Administration to oppose deep cuts to Medicare reimbursements for medical imaging. If you encourage your loved ones to undergo regular screenings, and believe Ms. Begley???s piece undermines well-intentioned efforts to increase disease screening rates, then you should join the growing number of patient groups calling on policymakers to preserve access to medical imaging because it saves lives and money.
- 1
- 2
It May Not Save Your Life
Email To A Friend
Please fill in the following information and we'll email this link.
How unwelcome is this message? It is especially ironic that lung-cancer advocates are up in arms about the prospect of less access to imaging. "We know that early disease detection dramatically improves the chances of survival," said Sheila Ross, special counsel of the Lung Cancer Alliance and two-time lung-cancer survivor, said in a statement released by a PR firm working for the Access to Medical Imaging Coalition, which represents patient groups as well as physicians and companies that perform imaging or sell imaging equipment. The irony is this: screening for lung cancer has been an abysmal failure in terms of saving lives. And the one study that suggested it did has been engulfed in charges of ethics violations.
As for the ACS, it issued a statement saying that "the advantages of screening for some cancers have been overstated," but that it continues to endorse screening for breast, colon, and cervical cancers. The latter two are fairly uncontroversial (colonoscopy can detect polyps before they become malignant, and Pap smears detect precancerous cervical lesions). Mammography is on shakier ground, since the clinical trials that showed it to reduce the risk of dying of breast cancer were done before widespread use of effective new adjuvant treatments—that is, chemotherapy and radiation. The ACS does acknowledge that mammography "in some cases finds disease that does not need treatment." It hasn't recommended the PSA test for years, however.
The sad fact that lots of imaging does not unambiguously keep people healthy goes beyond cancer screening. Overuse of MRIs is especially rife in cases of back pain, as Nortin Hadler of the University of North Carolina at Chapel Hill details in his brilliant book Stabbed in the Back: Confronting Back Pain in an Overtreated Society(and as he explained in a JAMA paper two years ago). Worse, patients with low-back pain (the fifth-most common reason Americans go to a doctor) are more likely to have surgery if they're in an area with lots of MRI centers, scientists from Stanford University School of Medicine reported last week in the online edition of Health Affairs. And what's wrong with that? Surgery is notorious for not helping with back pain any more than, say, bed rest and exercise (and even sugar pills). But it poses a risk of much worse complications. "The worry is that many people will not benefit from the surgery, so heading in this direction [of expanding use of and access to MRIs] is concerning," said coauthor Laurence Baker of Stanford.
Just to make the rationing fearmongers even more hysterical: clinical guidelines say that patients with lower-back pain should wait four weeks before getting an MRI (which typically costs $1,500), since in most patients—yes, I said most—the pain goes away on its own. I can see the headlines now—what is this, Canada??!!—if doctors actually put those guidelines into widespread practice. As it is now, however, "the net result is increased risks of unnecessary surgery for patients and increased costs for everybody else," said John Birkmeyer, professor of surgery at the University of Michigan.
What effect will such scientific findings have on patients and doctors? "I don't think the country is yet prepared to hear such arguments," Hadler told me in an e-mail interview. "Screening has become an entitlement; to not [get] screening is un-American even when the screening test is inaccurate, invalid and offers no benefit."
Sharon Begley is NEWSWEEK's science editor and author of The Plastic Mind: New science reveals our extraordinary potential to transform ourselves and Train Your Mind, Change Your Brain: How a New Science Reveals Our Extraordinary Potential to Transform Ourselves .
© 2009
- 1
- 2
Discuss