Are You Being Overtreated?

Cancer tests don’t protect us as much as we think. In fact, some researchers believe they are overused.

“Screening for cancer means that tens of thousands of patients who never would have become sick are diagnosed with this disease,” says H. Gilbert Welch, MD, co-director of the Outcomes Group at the Veterans Affairs Medical Center in White River Junction, Vermont, and a leading expert in cancer screening. “Once they're diagnosed, almost everybody gets treated-and we know that treatment can cause harm.” Tamoxifen for breast cancer can trigger life-threatening clots in the lungs, for instance. Surgery for prostate cancer leaves 60 percent of men unable to have an erection. For that matter, some of the screening tests themselves carry risks: Up to 5 out of every 1,000 people who get a colonoscopy have a serious complication, such as a colon perforation or major bleeding.

Most people diagnosed with cancer undoubtedly see these risks as the price they must pay to avoid dying of cancer. “The reality is not so simple,” says Dr. Welch. Screening tests are very good at catching tumors that would never bother us, he notes, but they're actually pretty bad at catching the fastest-growing and most deadly cancers in time to cure them.

To Screen or Not to Screen

The right time to screen:

• You have a family history. If you have close relatives with cancer, your own risk of developing it may be above average. Generally, only immediate relatives (mother, father, sibling, child) count toward your family history.
• You know you have a risky mutation. The BRCA1 and 2 mutations are known to increase the risk of breast and ovarian cancers. Other mutations have been tied to colon cancer.
• You've already had cancer. One bout slightly increases your odds of developing another, unrelated cancer.

Think twice if:

• You have another serious illness. Having heart disease or suffering a stroke increases the odds that you'll die before an undetected cancer could cause symptoms.
• You're under 50 or over 70. There's less evidence to support getting screened in your 40s, when cancer risk is low. After 70, the possible benefit from early treatment should be weighed against the chance that it will make life less enjoyable or more painful.
• You're frail. If you can't withstand treatment, it may not be useful to undergo a screening test.
• You're particularly afraid of being harmed by treatment you don't need.

More Overused Treatments

Screening tests aren't the only medical “miracle” that may be overused. Studies show that doctors tend to be too quick to use several other types of tests and treatments:

Imaging tests. Not every bump on the head requires a CT scan, which packs a lot of radiation. For the same reason, people without symptoms of heart disease should be cautious about cardiac CT exams. Many MRIs for lower-back pain are also unnecessary, studies show.

Back surgery. Spinal fusion, which involves welding together vertebrae with bone grafts or metal devices, appears to offer no more relief than less risky (and less expensive) rigorous rehab programs for worn disks. Most back pain goes away on its own.

Cardiac procedures. Solid evidence shows that, if you have heart disease, unless you're in the midst of a heart attack or in its immediate aftermath, getting an angioplasty or a stent adds no survival edge beyond that provided by drugs and lifestyle changes.

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