New cancer screening feeds overdiagnosis debate

MeMe - Raises Her Hand (-_-) (Mommy Of A Toddler And Teen) - posted on 04/23/2012 ( 4 moms have responded )




Cancer was on Gritley Henry's mind when Dr. Jonathan Aviv treated her for a cough that had bested other doctors for a decade. "But I was too nervous to mention it," says the grandmother of three.

She didn't have to.

The vocal-fold disorder Aviv had diagnosed as the cause of the cough was already responding to treatment when, during a follow-up visit, the doctor threaded a thin flexible tube tipped with a camera into Henry's nose and down her throat. She sat wide awake as Aviv checked out her voice box. Then, though Henry had no symptoms of esophageal cancer, Aviv pushed the tube farther down her gullet, used the device to take a biopsy, and looked for signs of the precancerous cells known as Barrett's esophagus.

Screening for rare but deadly esophageal cancer is typically a laborious and costly procedure, requiring sedation and a day off from work. The new technology Aviv uses makes it a cinch.

That's why the few minutes he spent on Henry's screening threatens to open a new front in the fight over the costs and benefits of looking for disease in patients who aren't sick.

Aviv and his partners at Tarrytown, New York-based ENT and Allergy Associates LLP, which advertises itself as the largest ear, nose and throat practice in the United States, want everyone age 50 or older to undergo esophageal cancer screening. And they are working the media to promote transnasal esophagoscopy, or TNE, as the new technique is called.

Early detection, Aviv and other proponents say, could dramatically reduce the number of deaths from esophageal cancer, and at lower cost than traditional endoscopy. "The disease is devastating … and it's very easy to stop," Aviv says. "Everyone over 50, just like they have a screening colonoscopy, should have a screening esophagoscopy."

The situation is similar in other countries, where TNE is available but not widespread. In Europe, the British Society of Gastroenterology says it can't recommend screening even for people with heartburn, considered a risk factor for esophageal cancer, because there is no evidence that doing so "is worthwhile and benefit is so unlikely."

While the cost of TNE is lower on a per-patient basis than traditional endoscopy, critics say testing millions of people would needlessly add billions of dollars to the already bloated U.S. national health bill and lead to lifelong follow-up testing for many people who would never get the disease.

"You are going to end up hurting a lot of people, and it's not clear to me you're going to help very many," says Dr. Otis Brawley, chief medical officer of the American Cancer Society and author of "How We Do Harm: A Doctor Breaks Ranks About Being Sick in America." "The simple, ‘Let's find it early, let's not pay any attention to the potential for harm' -- that same thought process is what started prostate cancer screening."

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Well, I for one would not have a problem with such a test after age 50. I do have an issue though, if it has not been proven to help detect an early onset or if it does, to increase ones chances of getting rid of it, since it would cost a lot of money and resource.

I think they need to first figure out the benefits of knowing early on and whether the chances of catching it early will help a person be rid of it.

What do you think? Would you be for this type of test?


Jodi - posted on 04/23/2012




I'm failing to see how this could be called overdiagnosis when it comes to cancer. It is either diagnosed through early screening or it doesn't. Personally, I think they've used the wrong term there.

With the rest of it, I am still considering it. I can definitely see the advantage of it with many cancers, because it is often too late by the time symptoms present themselves. I don't profess to know about most cancers, but something like melanoma benefits from removal and testing of certain moles on the body for cancerous or precancerous cells, even if they only just look suspicious. I go for screening by a specialist dermatologist every year. So far, I have only had one biopsy. But the thing is, if you don't do this, often by the time this cancer is found, it is far too late, especially as it is one of the fastest developing cancers out there. You can literally go from diagnosis to death in a matter of months.

So I think it depends on the cancer as to what screening should take place.


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Erin - posted on 06/07/2012




You know what this is. I do it's the premptive nanny state trying to cut costs of UHC by denying reasonable testing for the elderly. They've been doing this now for months hoping to save a buck later. It makes me quite mad.

MeMe - Raises Her Hand (-_-) (Mommy Of A Toddler And Teen) - posted on 04/24/2012




Jaime--- 50 isn't old at all. It may sound old but it really isn't. What about your children? Just curious. A regular checkup is sooo important.

[deleted account]

see, this is why i don't understand capitalism, but that's an entirely different subject...

i'll be one of those people who never go in for a check-up, seeing as how i already AM one of those if i get colon cancer or esophageal cancer or pretty much anything they screen for when i get to be an old fart, i'll just die. such is life.

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