CHICAGO — Too much cancer screening, too many heart tests, too many cesarean sections. A spate of recent reports suggests that many Americans are being overtreated. Maybe even President Barack Obama, champion of an overhaul and cost-cutting of the health care system.
Is it doctors practicing defensive medicine? Or are patients so accustomed to a culture of medical technology that they insist on extensive tests and treatments? A combination of both is at work, but new evidence and updated guidelines are recommending a step back and more thorough doctor-patient talks about risks and benefits of screening tests.
Americans, including the commander in chief, need to realize that "more care is not necessarily better care," wrote cardiologist Dr. Rita Redberg, editor of Archives of Internal Medicine. She was commenting on Obama's recent physical.
His exam included prostate cancer screening and a virtual colonoscopy. The PSA test for prostate cancer is not routinely recommended for any age and colon screening is not routinely recommended for patients younger than 50. Obama is 48. A White House spokesman noted that earlier colon cancer screening is sometimes recommended for high-risk groups, such as blacks.
Doctors disagree on whether a virtual colonoscopy is the best method. But it's less invasive than the traditional procedure and doesn't require sedation — or the possible temporary transfer of presidential power, the White House said.
Yet Redberg, a doctor with expertise in health policy, takes issue with that test and a heart scan to look for calcium deposits in the president's arteries. She said the calcium check isn't recommended for low-risk men such as Obama.
And the colon exam exposed him to radiation "while likely providing no benefit to his care," she wrote in an editorial in the medical journal. Obama's experience "is multiplied many times over" at a huge financial cost to society, and to patients exposed to potential harms but no benefits.
"People have come to equate tests with good care and prevention," said Redberg, of the University of California at San Francisco Medical Center. "Prevention is all the things your mother told you — eat right, exercise, get enough sleep, don't smoke — and we've made it into getting a new test."
This week alone, a New England Journal of Medicine study suggested that too many patients are getting angiograms — invasive imaging tests for heart disease — who don't need them; and specialists convened by the National Institutes of Health said doctors are too often demanding repeat cesarean deliveries for pregnant women after a first C-section.
Cancer-screening disagreement
Last week, the American Cancer Society cast more doubt on routine PSA tests for prostate cancer. And a few months ago, other groups recommended against routine mammograms for women in their 40s, and for fewer Pap tests looking for cervical cancer.
Experts dispute how much routine cancer screening saves lives.
It also sometimes detects cancers that are too slow-growing to cause harm, or has false-positive results leading to invasive but needless procedures — and some risks. Treatment for prostate cancer that may be too slow-growing to be life-threatening can mean incontinence and impotence. Angiograms carry a slight risk for stroke or heart attack.
Not all doctors and advocacy groups agree with the criticism of screening. Many argue that it can improve survival chances and that saving even a few lives is worth the cost of routinely testing tens of thousands of people.
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