Yesterday, I exposed the lack of “standards of care” when it comes to cancer screening recommendations for breast cancer, cervical cancer, and colorectal cancer.
The quality of the screenings varies greatly as well. For example, as I mentioned yesterday, we have a very safe and effective screening tool for cervical cancer: the Pap smear. But mammography, the screening tool for breast cancer, is not very effective, and it does very little to save lives. It’s such a poor tool, the efficient Swiss Medical Board has stopped recommending annual mammogram screenings for women altogether.
Too bad the crony capitalist mainstream government-industrial-medical complex in the U.S. sees things much differently…
In 1992, the Mammography Quality Standards Act tasked the FDA with developing regulations for mammography performance, facility inspections, and other quality measures. The National Breast and Cervical Cancer Early Detection Program established timelines for following up after screening: women should have diagnostic testing less than two months after a “positive” screening, and they should begin treatment less than two months after a “cancer” diagnosis.
Of course, the law of unintended consequences kicked in as usual whenever the government gets involved. This law basically tells doctors and patients what they have to do, and when, after a breast cancer diagnosis.
This rush to judgment and rush to action greatly contributes to the epidemic of over-diagnosis and over-treatment, considering the number of false positives and faulty diagnoses of “cancer” when there is no malignancy.
And it’s all futile in the end, as far as actually preventing breast cancer deaths according to national studies in Canada, Switzerland and elsewhere.
Once again, the road to perdition is paved with “good” intentions — and the road signs bear the initials CDC, FDA, and NIH.
Colorectal cancer screening goes to the opposite extreme
In my view, these government programs are at the extremes of folly.
At the one extreme, we have breast cancer. The government mandates rapid follow-up after screenings. They achieve uniform methods and rapid test completion, but with only modest patient outcomes (if any), despite the huge costs.
It also clearly contributes to, and even “mandates,” the rush to judgment, causing an epidemic of over-diagnosis and over-treatment, exposing many women to needless harm, costs and worry. All without any overall benefits for actually reducing breast cancer deaths.
Unfortunately, the U.S. government doesn’t base these breast cancer screening recommendations on actual scientific evidence. If they did, they would know (as the efficient Swiss now know) that mammography doesn’t improve outcomes. It only increases the costs and harms to the patient.
At the other extreme, we have colorectal screening. There are no uniform, quality measures or performance standards at all for following up after colorectal cancer screening. No laws exist that mandate timely follow-up after screening. But in this case, it would make a difference in outcomes, since data show the harms from delaying follow-up.
Cervical cancer falls in much the same ignored and overlooked category of cancer screening.
So why do they have it exactly backwards?
The government puts standards in place where it doesn’t really make a difference. But it doesn’t put standards in place where it would make a difference!
Yes, doctors seem to persistently recommend cancer screenings for all three types of cancer. But it’s all just talk when it comes to colorectal and cervical cancer. Especially since we don’t have mandated standards of care for how often men and women should receive these tests — or standards for costs, quality, follow-up, and reporting.
The only thing the government guarantees is more useless spending, not patient health or safety.
It’s time to start over. We need new standards, across the board.
“Reducing Variation in the “Standard of Care” for Cancer Screening,” Journal of the American Medical Association (www.jamanetwork.com) 4/18/2016