Wednesday, March 11, 2015

Overdiagnosed and overtested

You are diagnosed with cancer after some tests. Then you are sent for more tests to figure out the best course of treatment. You feel tested to death - too many injections, IVs, scans, and time in waiting rooms. Finally you get a course of treatment. Did you really need all those tests?

New diagnostic tests keep being developed to help determine the best course of treatment for a patient. But how much of their results are really helping doctors and patients? A recent study confirmed that the doctors see the tests as confirmation of their recommendations. And that patients do not really understand the results.

I have been on numerous breast cancer boards where women question the significance of the results of their Oncotype DX and other tests. "My results were this and my doctor said this, what should I do?"

"Fourteen oncologists were surveyed at teaching and community hospitals in Toronto. Most said the tests enhanced their confidence in deciding whether to recommend chemotherapy in cases where the best course of action was unclear to both the physician and the patient - especially when they were truly undecided. While most said the test supported their assessment rather than altering their practice, one oncologist described the test as a "tie-breaker."

But they raised concerns about overuse and inappropriate use of the test; over-reliance on the test relative to other, more established pathological indicators; the fact that testing takes places in only one lab in California; aggressive marketing of the test and its high cost, about $4,000.

Dr. Bombard said these reservations were consistent with general concerns about overuse of laboratory testing, which has increased rapidly, contributing to the financial strain on health care systems. Estimates suggest that 10 to 50 per cent of lab tests in Canada might be unnecessary and one-third of U.S. health-care spending results from overuse or misuse of tests, procedures and therapies."

This last sentence sums it up for me. Do we need all these damn tests? Just because we can test for something do we really need to?

1 comment:

Becky said...

One of the reasons I choose the oncologist that I did was that he didn't believe in unnecessary tests - if it wasn't going to change the course of treatment, it wasn't necessary, period ... and so I avoided some tests (e.g. axillary node dissection pre-chemo) because i was doing the chemo anyways ... we didn't onco-type either, because it was not relevant in my case ... I do see it as useful as a "tie-breaker" or in the cases where the recommendations are really not clear, but good to avoid if you don't need it ... onco-type isn't a great example because it is not invasive ... unlike MRIs, Mammograms, and CT Scans ...