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Patients unaware of screening’s risk for overdiagnosis, overtreatment
Most patients were misinformed by their doctors about the risks for overdiagnosis and overtreatment caused by cancer screening, according to study results.
Researchers conducted a survey of 317 adults aged 50 to 69 years, most of whom were white (84.9%) and women (52.4%). Participants had no prior history of cancer and had been prompted to undergo screening by their physicians.
Overall, 19.9% of survey respondents reported undergoing routine cancer screening once, 36% reported undergoing screening twice, and 27.1% reported undergoing screening three times or more. Seventeen percent of respondents underwent no cancer screening.
Among women, mammography was the most commonly reported cancer screening, whereas men most frequently underwent colonoscopy/sigmoidoscopy and PSA testing.
Eighty percent of participants said they wanted to be informed about their risks for overdiagnosis and overtreatment from cancer screening before undergoing the testing. However, only 30 respondents (9.5%) said they were informed by their physicians about these risks. Nine of those 30 participants reported receiving quantified information on the risk for overdiagnosis, but the numbers reported were overestimated or underestimated in all but one instance, researchers wrote.
Nine of the 27 participants who did not undergo cancer screening and who had received information about its potential risks refrained from screening because of this information.
Results indicated that 58.9% of participants would have continued to undergo routine cancer screening even when told that screening results in 10 cases of overtreatment per one life saved.
“Our results should prompt medical educators to improve the quality of teaching about screening and encourage medical journal editors to enforce clear reporting about overtreatment when publishing results on the effectiveness of cancer screening,” researchers wrote. “These means may not be sufficient but would be a first step toward enhancing the number of physicians and patients who thoroughly understand the potential consequences of taking a cancer screening test.”
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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This issue has not been fully explained to most patients. I try to explain it, but it is a very difficult task. Patients do not easily grasp the differences between lethal and nonlethal prostate cancer. In the pressure of private practice, seeing 20 to 30 patients per day, this discussion can be extremely time-consuming and thus costly. Doctors have to be parsimonious with their time, and we want to be sure our patient does not have a bad cancer. I recommend the biopsy and, and if the patient has a bad cancer, I have to invest my time there. If the patient has nonlethal cancer, I can breathe a sigh of relief and then slowly explain that to patients over the course of several visits. Once we know it is nonlethal, it is our job to explain it to patients and not overtreat.
Perspective
Back to TopOverdiagnosis and overtreatment of any disease comes hand-in-hand with screening, whether it is for prostate cancer, hypertension or high cholesterol. For a suspicious cancer or a low-risk cancer that may never cause the patient any problem, the stakes are much higher because biopsies, surgery and other cancer treatments can cause lifelong complications. Most of our patients go through life making complicated, informed decisions about their finances, business and personal safety. However, this cross-sectional survey shows that most people navigating cancer screening and treatment decisions may be “flying blind” and are not informed, or they may be misinformed and driven by fear of cancer. In fact, their tolerance for overdiagnosis on the average is much lower than most cancer screening tests can deliver.
Most physicians do not have immediate access to the latest statistics on screening performance and overdiagnosis/overtreatment outcomes as they may apply to individual patients based on their age and cancer risk factors. The decision to order a screening test usually takes a few seconds, or it is just “clicked on a checklist”, and it is not given much thought by either the caregiver or patient. We must therefore use information technology to develop and disseminate screening risk–benefit models that are easy to access and understand and that are vetted by both the professional and lay communities in order to improve decision-making for all screening tests.