No real “standards of care” when it comes to cancer screenings

According to a new editorial published in the Journal of the American Medical Association, there is little consensus about how often men and women should undergo “routine” cancer screenings.

In fact, it seems like every other week, physician groups, patient groups and advocacy groups issue changes to their policies, regulations and guidelines about who should get screened for cancer…how often they should get screened…when they should start…where they should get screened…which tests they should use, or not use…as well as who should pay for it. And these groups all make different recommendations.

For example, the American Cancer Society recommends women start to get annual mammograms at age 40. But the U.S. Preventive Services Task Force (USPSTF) now recommends most women can wait until age 50 to begin bi-annual mammogram screenings for breast cancer. Understanding and evaluating these differences can be incredibly frustrating and confusing for patients and doctors alike.

Typically, medical research guides medical practice by establishing these “standards of care,” based on scientific evidence.

Standards of care in medicine imply certainty and consensus about what the research shows and about what is best for the patient. They are also critical in my medical sub-specialty of forensic pathology in legal cases. In civil cases regarding medical care, the lawyer making a claim on behalf of a patient must establish what the standard of care is, that the treating physician(s) departed from that standard, and that harm to the patient directly resulted. Of course, it is all supposed to be based on the evidence.

But when it comes to cancer screenings, there are really no standards.

The new JAMA paper points out how differently even the federal government handles “routine” screenings for breast, cervical and colorectal cancers.

In 1990, Congress passed the Breast and Cervical Cancer Mortality Act to create the National Breast and Cervical Cancer Early Detection Program. The CDC administers the program. It provides what the government calls “free” breast and cervical cancer screening and diagnostic services to women ages 21 to 64 years who live 250 percent below the federal poverty level. In 2000, the Breast and Cervical Cancer Prevention and Treatment Act added cancer treatment as well through Medicaid coverage nationwide.

But colon cancer appears to get the short end of the stick, so to speak.

Colon cancer had to wait 20 years to get its own federal program

The USPSTF started making recommendations about colorectal cancer screening in 1996. But the CDC didn’t establish the Colorectal Cancer Control Program until 2009, almost 20 years after the breast cancer screening program began.

Plus, the program predominantly provides education and “outreach,” and very few screenings. Nor does it provide treatment. Finally, the program is not nationwide. And it only covers half the states and four Native American tribal reservations.

Now, let’s look at how many screenings these programs supported…

In 2013, the National Breast and Cervical Cancer Early Detection Program funded 331,313 breast cancer screenings and 208,682 cervical cancer screenings.

By comparison, the Colorectal Cancer Control Program funded a mere 13,425 colorectal cancer screenings in 2014 (the next year for which data is available).

This paltry number of screenings is just four percent of the breast cancer screenings performed. But colon cancer is the No. 3 cancer in both men and women. (Plus, if you want to get even more accurate, the target population of men and women is twice as large as women alone. So the effective rate of colon cancer screening was just two percent of breast cancer screenings if you use this more accurate approach.)

Here’s another interesting point…

The federal program funded just 208,682 cervical cancer screenings. In stark contrast to breast cancer screening, cervical cancer screening (the Pap smear) is very effective at preventing cancer and saving lives. Despite having this well-established, effective screening test, innocent young children routinely receive the deadly HPV vaccine to “prevent” cervical cancer. It makes no sense!

Mammography gets all the promotion, despite its lack of effectiveness

On the flip side, mammography screenings for breast cancer do not prevent cancer deaths. In fact, the efficient Swiss Medical Board has stopped recommending women get them.

Despite the ineffectiveness of mammography, mainstream medicine in this country has nothing and does nothing to prevent breast cancer by any other means. It steadfastly ignores all the scientific evidence about the ability of vitamin and mineral micronutrients to reduce breast cancer risk, improve survival rates, and improve quality of life in women with breast cancer.

To make matters worse, the government-industrial-medical complex overstates the benefits of routine cancer screenings (no matter how often they’re performed) and underrepresents the harms in about 80 percent of cases.

Tomorrow, I will tell you more about the crony capitalist medical crapshoot, so to speak, when it comes to colon cancer screening.


“Reducing Variation in the “Standard of Care” for Cancer Screening,” Journal of the American Medical Association ( 4/18/2016