Cancer in Perspective

Posted Dec. 07, 2009, at 7:01 p.m.

A cancer diagnosis is among the most devastating a person can receive. Yet, despite decades of research and treatment, doctors lack detailed information about what treatments have the best outcomes and which will make only a minimal difference. The result is that we spend billions of dollars on procedures that may or may not appreciably extend lives while causing others extreme anxiety over a misdiagnosis.

A better, but much more difficult route, is to have a dispassionate discussion of where treatment efforts should be focused. The recent backlash against a report that suggested most women should have fewer mammograms to detect breast cancer shows the pitfalls of this approach.

Such a backlash, however, cannot end this critical work. Two recent newspaper columns, one from this paper and the other from The Washington Post explain why.

“Globally, cancer care is a medical luxury,” wrote John L. Marshall, the director of the Otto J. Ruesch Center for the Cure of Gastrointestinal Cancers and the Lombardi Comprehensive Cancer Center at Georgetown University. “With some diseases such as colon cancer, the treatments alone cost more than $15,000 a month, yet on average add only a few months to survival.

“Most poor countries do not support any cancer care; most developed countries highly restrict it because of its cost and limited effectiveness,” he wrote in the Post. “The United States is the only place on Earth with relatively unfettered access to cancer care, including the latest medicines, sophisticated scans and high-tech radiation, all of which are very expensive.

“But despite their limited access, cancer patients in other high-income nations may live longer and with a higher quality of life than patients in this country,” Dr. Marshall concluded.

Certainly every medical decision does not come down to money, but if other countries are spending less and people are living longer, shouldn’t we find out why?

The problem, as Erik Steele wrote in his weekly column on these pages, is that “emotion and bias warp our judgment.”

The controversy last month over a report from the U.S. Preventive Services Task Force that recommended women without risk factors not start routine mammograms until age 50 and then get them every other year. The current federal recommendation, which was not changed based on the report, is for women to begin routine mammograms at 40 and get them yearly thereafter.

A study commissioned by the task force found that for every 1,000 women screened beginning at age 40, modeling suggested that just 0.7 deaths from breast cancer would be prevented while 480 women would get a false-positive result and 33 more would undergo unnecessary biopsies.

“So the next time some panel of experts trolls through the data and tells us that some kind of care we have been getting for a while might not be the best care, don’t shoot the messengers even if the message makes you uncomfortable,” Dr. Steele wrote. “We all need every bit of objective help we can get figuring out what health care is really worth having, because a lot of it is not.”

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