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Nov 19, 2009 11:21 pm US/Central
Good Question: Are We Ordering Too Many Tests?
(WCCO)
A group of scientists and researchers have changed their recommendation for when women get mammograms. The change provoked anger and hurt. However, the science indicates that mammograms are not effective in saving lives of women in the 40s.
The controversy brings up the idea of the abundance and cost of medical tests. Are we testing too much? And if so, what's the harm?
According to the American College of Radiology, we spend $100 billion dollars a year on imaging, scans and X-rays.
"There's nothing wrong with that other than statistically, it's not saving lives," said Dr. Steven Miles, professor and faculty member at the University of Minnesota's Center for Bioethics.
"If you came to my office, it would be easy for me to do a head CT-scan, a chest CT-scan, an angiogram, a PSA, a colonoscopy and look into your lungs. Whether I'm benefiting you is a separate issue," he said.
According to Miles, the United States orders more heart scans than any developed country, with the possible exception of Germany.
"Yet our heart attack mortality rates are no better. We don't gain anything by the visualization of these coronary arteries relative to other countries due to the test," he said.
Consumers are demanding them, however. That, coupled with concerns that doctors will be sued if they miss a diagnosis without ordering a scan, has resulted in record levels of medical tests.
The mammogram issue has been particularly contentious, despite the fact that research questioning the effectiveness of mammograms for women in the 40s is more than five years old.
"The mere fact that we have many women writing in saying, 'well, I got a mammogram at age 40 and it found the cancer,' is not the same thing as saying it saved their life," said Miles.
The same is true for tests that look for prostate cancer, where many researchers are wondering if the all-out effort to discover cancer early is necessarily a good thing.
Researchers say for women in their 40s, it takes 1,904 mammograms to save one life. When women get into their 50s, it's more than 1,300 mammograms to save one life. The highest rates of breast cancer are women in their 70s and 80s, and those are the women who aren't getting enough mammograms, according to Miles.
There's no question that in young women there is a high percentage of false positives, tests that indicate cancer, but turn out to not be cancer at all.
"The ability of a mammogram to save lives requires several thousands of women to be subjected to radiation, potentially needless biopsies at great expense in order for one positive result to happen," said Miles.
Although the U.S. Agency for Healthcare Research and Quality has been quite clear that the cost savings was not part of its calculus in changing their guidelines, Miles said it's hard not to think of what we could do with the money spent on unnecessary and ineffective tests.
There could be more money for prevention of medical problems, insuring more people, or tests that saved more lives.
"We have a health care system that costs twice as much as any other health care system, without demonstrably better outcomes," said Miles.
(© MMX, CBS Broadcasting Inc. All Rights Reserved.)
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