medical care is a consumer good, one which we consume entirely too much . . .

We only find the less deadly cancers.

"A new report raises fresh questions about the value of mammograms. The rate of cancers that have already spread far beyond the breast when they are discovered has stayed stable for decades, suggesting that screening and early detection are not preventing the most dangerous forms of the disease.

The report, in Thursday's New England Journal of Medicine, is by three prominent cancer specialists and is based on federal statistics going back to the 1970s.

It comes a week after the American Cancer Society scaled back its mammography advice, saying most women should start annual screening at age 45, not 40, and switch to every other year at 55. A government task force recommends even less -- every other year starting at 50.

"We're undergoing what I think for the public is a very confusing debate" about screening, but it's really "a course correction" prompted by more awareness of its risks and benefits to various groups of women, said Dr. H. Gilbert Welch, a health policy expert at Dartmouth Medical School. "All they heard for years was, 'there are only benefits.' "

He is the lead author of the report, co-written with Dr. David Gorski of Wayne State University School of Medicine in Detroit and Dr. Peter Albertsen of the University of Connecticut Health Center in Farmington.


"Screening offers hope that cancer can be detected in an early, localized phase when it's more amenable to treatment," they write, but that assumes that cancer starts in one place, grows and then spreads. If that was always true, screening would reduce the rate of advanced cancers.

And that has not happened. The rate of breast cancers detected at an advanced stage has been stable since 1975, despite wide use of mammography since the 1980s. The average age of women diagnosed with cancer also has remained around 63, another sign cancers are not being found sooner.

The trends suggest that some breast cancers are already "systemic" or widely spread from the start, and that finding them sooner has limited impact.

"Screening mammography has been unable to identify those bad cancers, destined to become metastatic, at an earlier stage. That doesn't say mammography doesn't help less aggressive cancers," but those are less likely to prove deadly, Welch said."

The rate of cancers that have already spread far beyond the breast when they are discovered has stayed stable for decades – Lowell Tech Air - Albany Daily Star Gazette

This is true for many cancers. We need to seriously rethink the hype we are hearing surrounding preventative medicine, and testing. Much of this is little more than cross selling for doctors who own shares in the lab. 

Nearly every doctor to whom I speak with has a litany of anecdotes of people helped by their pet procedure, whether mammography, PSA, colonoscopy, or something else. But when I ask about problems, negative outcomes, and the like, its is as if they have never heard of such a thing. Yet as a litigator handling medical cases, I saw these, commonly. 

If we allow government to infringe on our medical payments we will see a significant reduction in quality of care. Instead of careful analysis of whether colonoscopy, sigmoidoscopy, FIT or some other non-invasive test is better, we will see the wizened mandarines simply making a decision and then subjecting us to their dictate. Are their good quality comparative studies in the medical literature about the long term efficacy of these testing procedures, have they been studied comparatively? No.

The colonoscopy became the gold standard because Medicare agreed to pay for the procedure even without high quality comparative studies, because it looks at more, and thus, must be better. So, they dictated this outcome without evidence. The insurance companies all but had to go along since every gastroenterologist bought a colonoscopy machine. Why not, it pays the doctor far more than the competitor machine. 

Europe has been doing some minor comparative studies which seem to show the colonoscopy is no better than the sigmoidoscopy but does have higher incidence of complications. 

Whether cancer, or other medical treatment, these issues need to be much more front and center in our debate.

To get a baseline grasp on this problem I suggest reading:

Overdiagnosed: Making People Sick in the Pursuit of Health 1st Edition by H. Gilbert Welch

Should I Be Tested for Cancer?: Maybe Not and Here's Why Paperback – March 6, 2006 by H. Gilbert Welch

Less Medicine, More Health: 7 Assumptions That Drive Too Much Medical Care 1st Edition by Gilbert Welch

Know Your Chances: Understanding Health Statistics Paperback – November 30, 2008 by Steven Woloshin M.D.M.S.