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Cancer screening tests right to the grave

Posted by medconsumers on October 13, 2010

When my husband and I picked up his mother after yet-another hospitalization for complications of congestive heart failure, I read her discharge orders. “Be sure to schedule a Pap test and a mammogram after you get home.” Naturally, we ignored the directive as absurd for a woman in her mid-nineties who clearly had a condition that would soon cause her death.

Apparently, this is more common than I’d ever imagined. A new study, published today in the Journal of the American Medical Association, found “a sizeable proportion” of people with terminal cancer are given screening tests for common cancers. And the testing is beyond the two recommended to my mother-in-law. Nearly 9% of the advanced cancer patients in this study were tested for new cancers.

Here’s how the study, funded by the U.S. National Cancer Institute, was done. Researchers at Memorial Sloan-Kettering Cancer Center, New York, searched the data from Medicare claims to determine the number of cancer screening tests given for new cancers to people already diagnosed with an advanced cancer. The reseachers assessed data on 87,736 people ages 65 and older who had been diagnosed with advanced lung, colorectal, pancreatic, gastroesophageal, or breast cancer between 1998 and 2005. All were followed up until death or December 2005, whichever came first. Each was matched by age, sex, and race to Medicare enrollees without cancer.

Keep in mind that screening is the testing of people without symptoms, and the tests may have been ordered without much thought as to what would be done once a new cancer is detected. Would a surgeon do a prostatectomy on a man with an incurable cancer some place else and a life expectancy of less than two years? I suspect the answer is yes. Why else would the test be ordered?

The tests most commonly given to advanced cancer patients were predicable. Mammography was number one, received by nearly 9% of the women with advanced cancer, with the Pap test running a close second at nearly 6%. As for the men, 15% got a PSA test and nearly 2% of all got a colonoscopy. As for the age-matched people without cancer in the control group, 2-3 times more of them had at least one of the cancer screening tests.

Who are the most likely to be screened right to the grave? Married people with higher socioeconomic status. And people who were screened regularly before they were diagnosed with the cancer that would eventually cause their death.

On this last point the research team led by Camelia S. Sima, M.D., hypothesized that “efforts to foster adherence to screening have led to deeply ingrained habits. Patients and their health care practitioners accustomed to obtaining screening tests at regular intervals continue to do so even when the benefits have been rendered futile in the face of competing risk from advanced cancer.”

Maybe so, but I suspect that something more than mindless aggressive testing is at play here. America has a death-denying culture. Continued testing keeps hope alive and avoids that unpleasant conversation about the end-of-life. It’s not over until your doctor stops ordering cancer tests.

Maryann Napoli, Center for Medical Consumers©

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