Imaging Tests Up Among Advanced Cancer Patients

HealthDay – 1 hr 50 mins ago TUESDAY, July 31 (HealthDay News) -- A new U.S. study finds that the use of diagnostic imaging tests in Medicare patients with advanced cancer has risen faster than among patients with early-stage cancer.

The costs of diagnostic imaging have increased more than the overall costs of cancer care, making diagnostic imaging the fastest-growing part of Medicare-reimbursed services, the researchers noted. Medicare is the U.S. government-funded health insurance program for people over 65 and certain other patients.

They added that cancer care costs are highest during the last year of life, but little is known about the use of high-cost imaging tests in cancer patients during their final year.

In this study, the researchers examined data on the use of CT, MRI, PET and nuclear medicine scans for Medicare patients with late-stage (stage 4) breast, colon, lung or prostate cancer between 1995 and 2006. Stage 4 cancer means the cancer has spread throughout the body.

The analysis revealed that most of the patients underwent imaging procedures during the course of their care, and that the use of imaging in late-stage cancer patients increased between 1995 and 2006.

The study was published July 30 in the Journal of the National Cancer Institute.

The increasing use of imaging in late-stage cancer patients may be due to a lack of guidelines in this area or the use of imaging to help doctors manage symptoms, detect disease progression and assess the effects of treatment, said Dr. Yue-Yung Hu and colleagues at the Dana-Farber Cancer Institute, Brigham and Women's Hospital, and the University of Wisconsin.

While imaging often leads to appropriate measures to ease dying patients' suffering, it can also distract them from focusing on achievable end-of-life goals, cause them to spend more of their remaining time in medical care settings, and provoke anxiety, the researchers said.

Determining the most appropriate care for patients with late-stage cancer is complex, Drs. Robin Yabroff and Joan Warren, of the Health Services and Economics Branch at the U.S. National Cancer Institute, noted in an accompanying editorial.

"Physicians tend to overestimate survival for terminally ill cancer patients, which may influence their treatment and related imaging recommendations," they wrote in a journal news release. "Development of practice guidelines for advanced imaging in patients with stage IV disease, with explicit statements about the state of evidence will be critical, particularly for care outside of the window surrounding patient diagnosis."

More information

The American Cancer Society offers advice for cancer patients nearing the end of life.

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Many Teens With High Blood Pressure Don't Get Needed Tests

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Walgreen, others offer free HIV tests in CDC pilot

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CDC trying out free AIDS tests at drugstores

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Task Force Calls Routine Prostate Cancer Tests Unnecessary

This story comes from the Yahoo! Contributor Network, where individuals publish their unique perspectives on some of the world’s most popular websites.Do you have a story to tell? Become a Yahoo! contributor

When it comes to middle age, routine prostate cancer screening tests are to men what mammograms are to women. However, a federal task force believes administering the prostate-specific antigen (PSA) test on a routine basis to healthy middle-aged men is a waste of time.

According to the U.S. Preventive Services Task Force (USPSTF), the PSA test might cause more harm than good. The task force is an independent group authorized by Congress in 1984 and supported by the U.S. Department of Human Services. Its 16 volunteer members represent various medical fields. Its job: improving the health of Americans by making recommendations about clinical preventive services like screenings, medications, and counseling.

The task force says that prostate cancer is the most frequently diagnosed non-skin cancer in U.S. men. The lifetime risk of a diagnosis is an estimated 15.9 percent. The likelihood of actually dying of this type of cancer is less than 3 percent, and the disease is rare before age 50. Around 70 percent of the deaths attributed to it occur in men older than 75.

The USPSTF findings suggest that routine PSA testing would help save the life of just one man out of 1,000. According to the Washington Post, the recommendation concludes that for every patient saved by a PSA test, one will develop a serious blood clot, and two will experience heart attacks. Another 40 will experience impotence or incontinence after unnecessary treatment. However, patients with urinary symptoms such as pain or trouble urinating might benefit from the screening, the USPSTF concluded. Urologists expressed a very negative reaction to the recommendations.

A PSA test doesn't actually detect cancer. It finds a protein manufactured by the prostate. A number of benign prostate problems can cause elevated numbers of protein. This might mean a false positive leading to biopsies and other testing.

Most doctors don't rely solely on a PSA test when a patient has symptoms that might point to prostate cancer. A man who has reached his forties might also experience a digital rectal exam, ultrasound, and/or a transrectal biopsy of the prostate, says the Mayo Clinic.

Results of a PSA test with elevated numbers struck home last year. A family member with a history of low numbers went in for another routine screening. The PSA numbers had increased significantly but were still within normal range. Told to return in six months, he showed up, non-symptomatic, for the second blood test on schedule. The numbers were a bit higher but still within normal range.

Two weeks later, he underwent outpatient biopsies. He likened the procedure to a dozen cookie cutters powered by a pneumatic drill. He bled for days and experienced pain for weeks. There was no cancer. He has no plans to undergo additional routine prostate cancer screening.

Vonda J. Sines has published thousands of print and online articles. She specializes in health and medical topics, with a particular interest in diseases and other conditions that affect quality of life.

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Many pregnant women may not get STD tests

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Medical Tests You May Not Need

each revealed their lists of the top five overused tests or procedures in their fields. The resulting list of 45 tests has been made public as part of ABIM's Choosing Wisely campaign, an effort to boost communication between patients and physicians, and scale back on unneeded medicine in the process.

Could You Be Denied Coverage Because You're a Woman?

Here, we get to the bottom of the buzz to see what these new recommendations mean for you.

Early Detection Is Not Prevention

"Do we do too many tests? Absolutely," says Dr. Mary Jane Minkin, Prevention advisor and clinical professor of obstetrics and gynecology at the Yale School of Medicine.

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Many tests follow surgery for early breast cancer: study

Reuters – 4 hrs ago (Reuters) - Women who have early breast tumors surgically removed may often go through repeat mammograms and invasive procedures for years afterwards, with two-thirds having at least one more invasive procedure over the next decade, according to a U.S. study.

The study, which covered nearly 3,000 women, focused on so-called ductal carcinoma in situ, or DCIS - abnormal cells in the milk ducts that are considered the earliest stage of breast cancer. The most common treatment involves removing only the abnormal tissue and conserves the breast.

But researchers said the findings, which appeared in the Journal of the National Cancer Institute, pointed to a downside of breast-conserving surgery for DCIS.

"Women making treatment decisions about DCIS need to understand that many women will need additional surgery or invasive intervention after breast-conserving surgery," said Joshua Fenton, an assistant professor at the University of California, Davis, who co-wrote an editorial published with the study.

The most common invasive procedure is usually a biopsy to remove abnormal tissue in the same breast.

Of the 2,948 women in the study, all of whom had breast-conserving surgery for DCIS between 1990 and 2001, 41 percent had at least one mammogram to check out symptoms or a suspicious lump. And 66 percent had at least one invasive procedure.

But only eight percent actually had a DCIS recurrence and another eight percent were found to have invasive breast cancer.

Larissa Nekhlyudov at Harvard Medical School and Harvard Vanguard Medical Associates in Boston, who led the study, said women should be aware that breast conserving surgery can come with a long follow-up.

"We're not suggesting that women have a mastectomy instead," she said.

"The good news is that the majority of these women will not have a (cancer) recurrence. But the work-ups for a possible recurrence are likely to continue for years."

The findings fit into the bigger issue of the pros and cons of mammography screening. In the United States, the government-backed U.S. Preventive Services Task Force recommends screening women ages 50 to 74 every other year. Some medical groups, though, call for regular mammograms for all women from age 40.

Since mammograms came into widespread use in the 1980s, the number of DCIS diagnoses has shot up. About one in five newly-diagnosed breast cancers is DCIS.

The problem is that DCIS may or may not progress to tumors that invade the breast tissue, and currently there is no way to predict which cases will progress.

So women with DCIS almost always receive treatment, which for some may be unnecessary.

When it comes to early prostate cancer, which is also usually caught through screening, men have the option to delay treatment and choose "active surveillance" - where the cancer is monitored to see if it's progressing.

That's because prostate cancer is frequently slow-growing and may never threaten a man's life.

But this is not an option for DCIS yet since there's no way of telling which tumors might progress quickly, although it could become one if researchers find certain tumor characteristics that strongly predict it's benign, Fenton said.

This will also probably take a "cultural shift," Nekhlyudov noted, since people typically want aggressive treatment for cancer, even if it's early stage. SOURCE: http://bit.ly/IEYv3o

(Reporting from New York by Amy Norton at Reuters Health; editing by Elaine Lies and Bob Tourtellotte)

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DNA tests uncover hazards in Chinese therapies

"A traditional Chinese physician prepares herbal medicine for a patient at a clinic. A host of potential toxins, allergens and traces of endangered animals showed up in DNA sequencing tests on 15 Chinese traditional medicines, researchers said on Thursday. (AFP Photo/)" title

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Physicians Change Recommendations for Many Medical Tests

This story comes from the Yahoo! Contributor Network, where individuals publish their unique perspectives on some of the world’s most popular websites.Do you have a story to tell? Become a Yahoo! contributor

Several physician specialty groups have provided lists of medical tests or treatments they have deemed unnecessary or used too frequently, as part of the ABIM Foundation's Choosing Wisely project. There's a range in recommendations, from refraining from imaging tests for uncomplicated headaches via the American College of Radiology to refraining from routine antibiotic treatment of acute sinusitis that has lasted less than 5 to 7 days via the American Academy of Family Physicians.

Forty-Five Tests Make List of Recommended Changes in Use

The lists were made available on Wednesday as part of a joint effort between the ABIM Foundation and Consumer Reports to lower overall health care costs that is due to medical testing of questionable value. Each of nine physician specialty groups provided a list of five medical tests or procedures in their field of expertise that require closer consideration by practicing physicians before using.

Why a Change in Typical Medical Care Is Needed

Christine K. Cassel, M.D. and James A Guest, J.D. explain the need for these and additional changes in health care in an April 4 article published in The Journal of the American Medical Association. The current system of health care in the United States continues to demonstrate rising costs with "high rates of poor-quality care."

Physicians have been burdened with the fear that if some tests/procedures/treatments are not ordered for patients, even if the ratio of need to potential outcome is low, they would open themselves to increased chances of medical malpractice suits.

Realizing that changes need to be made to the health care delivery system, the ABIM Foundation, the European Foundation of Internal Medicine and the American College of Physicians Foundation together established a charter that would ultimately lead to "Choosing Wisely" in an effort to ensure quality patient care, as explained in an article published in a 2002 Annals of Internal Medicine article.

Suggested Changes that Affect Baby Boomers Health Care Decisions

Many of the changes suggested in the "Choosing Wisely" lists affect people of all age groups, while others will affect certain age groups more than others.

The suggested "Five Things Physicians and Patients Should Question" list provided by the American College of Cardiology is most relevant for baby boomers and their seniors that includes not performing annual stress cardiac imaging on patients without symptoms of heart problems and only perform an echocardiogram for mild, native valve disease when symptoms are present.

The American College of Gastroenterology in its list of suggested changes recommends that in average-risk individuals, no colorectal cancer screening needs to be performed in intervals briefer than 10 years for those who have already had a colonoscopy with negative results.

These and other suggested changes due in the fall of this year from eight additional medical specialty societies will likely impact the state of health care and its associated costs in the United States for years to come.

Smack dab in the middle of the baby boomer generation, L.L. Woodard is a proud resident of "The Red Man" state. With what he hopes is an everyman's view of life's concerns both in his state and throughout the nation, Woodard presents facts and opinions based on common-sense solutions.

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Green tea could cloud Olympic doping tests

Olympic doping officials are considering whether to tweak their tests after a recent British study showed green tea might hide testosterone from the standard test used to spot it.

The study was a test in a lab dish so scientists aren't sure if the effects will be the same in people. But some experts say the results are intriguing enough that Olympic testing could be updated to include that possibility.

"It's interesting that something as common as tea could have a significant influence on the steroid profile," said Olivier Rabin, scientific director of the World Anti-Doping Agency, or WADA. He said other foods and beverages, such as alcohol, are also known to muddle test results.

"We may need to adjust our steroid (test) to allow us to exclude whether a test is modified by food or training or disease, before we can say that it's doping," Rabin said. He said they might have to raise their normal threshold for what is a considered a legal amount of testosterone to allow for any such interference.

In the study, researchers added green and white tea extracts

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US doctors urge fewer tests, less costly treatments

"A technician reads a mammogram in 2006. Several leading US medical associations urged fewer tests for patients with mild health conditions and less aggressive treatment for advanced cancers in a bid to cut costs. (AFP Photo/Joel Saget)" title

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US health panel: Pap tests needed only every 3 years

Reuters – Thu, Mar 15, 2012 NEW YORK (Reuters Health) - Women only need to get a Pap test once every three years to check for cervical cancer, and don't need to be screened until age 21 - even if they're sexually active earlier, according to new guidelines from a government-backed panel.

The statement from the United States Preventive Services Task Force, released on Wednesday, aligns closely with guidelines from three U.S. cancer groups that were also announced on Wednesday.

Once they hit 30, women also have the option of getting screened once every five years if they choose to do Pap tests together with human papillomavirus (HPV) testing every time, the committees agreed.

"The bottom line is, we strongly recommend screening," said Dr. Virginia Moyer, chair of the USPSTF and a pediatrician at Baylor College of Medicine and Texas Children's Hospital in Houston.

The recommendation to test every three or five years is based on evidence that cervical cancer is relatively slow-growing, she said, so it's very unlikely a woman would develop advanced cancer in the few years after a negative screening.

"The women who get and die of cervical cancer are the women who aren't getting screened," Moyer told Reuters Health. "It's not the woman who hasn't had a screen in a couple years that's the problem."

Moyer's group attracted controversy late last year when it recommended against annual prostate cancer screening in men, after concluding that the possibility the tests could invite unnecessary and potentially harmful follow-up procedures outweighed their benefits.

The USPSTF's latest recommendations are based on a review of evidence on screening's success at detecting pre-cancerous lesions, as well as both physical and psychological side effects of Pap and HPV tests. Its guidelines were published in the Annals of Internal Medicine.

The task force found a benefit for Pap tests every three years in women age 21 to 65, or every five years when Pap tests and HPV tests are done together, starting at 30.

Screen more frequently, and the possibility of women getting complications from any related procedures - such as an exam and biopsy, called a colposcopy, following an abnormal Pap - outweighs any benefit to the extra tests.

Women under 30 shouldn't be tested for HPV because the sexually transmitted infection is common in young people and often goes away on its own, without increasing the cancer risk.

Women who are older than 65 and were screened regularly in the past are also probably in the clear, unless they're at particularly high risk due to a history of precancerous lesions.

Until there's more long-term data on women who've been vaccinated against HPV, they should continue getting normal screening, according to the report.

CANCER GROUPS AGREE

The guidelines broadly agree with others released by the American Cancer Society, the American Society for Colposcopy and Cervical Pathology and the American Society for Clinical Pathology. Those groups favor screening with both Pap and HPV tests every five years once women hit 30, but say every three years with Pap tests alone is also acceptable. Again, they recommend screening from age 21 to 65 in most cases.

In their report, released in CA: A Cancer Journal for Clinicians and other partner journals, the group's report estimates that without screening, 31 to 33 out of every 1,000 U.S. women would be expected to get cervical cancer in their lives. With Pap tests done every three years, that falls to five to eight per 1,000.

The relative benefit is slimmer when the tests are done more frequently, but the chance of having side effects from testing is just as high each time.

"Screening too much and too sensitively finds primarily benign infections that really would be better left unfound," said Philip Castle, head of the American Society for Clinical Pathology Institute, who worked on those guidelines.

"Doing more than what's evidence-based actually has potential harms for patients, and that shouldn't be minimized."

That includes the psychological harms of being told you have an abnormal test, he said. After that, some cervical procedures done as follow-up have been shown to increase women's chances of having a premature baby later in life.

According to the Centers for Disease Control and Prevention, about 12,000 U.S. women get cervical cancer every year - most caused by cancerous strains of HPV.

Castle said the focus needs to be on making sure that everyone gets the basic level of screening, especially poor women who live in isolated areas.

Moyer agreed that targeting those groups is going to make the biggest difference in cutting rates of new cervical cancer cases and deaths.

"We need to get the women who have not had a Pap smear in the past five years in," she said. "The women who aren't getting screened at all, that's the tragedy." SOURCES: http://bit.ly/an7XRm and http://bit.ly/yVwIPk Annals of Internal Medicine and CA: A Cancer Journal for Clinicians, online March 14, 2012.

(Editing by Michele Gershberg; Desking by Eric Walsh)

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