Dr. Len's Cancer Blog

At first glance, a scientific paper presented at the 58^th Annual Scientific Meeting of the American College of Cardiology in Orlando on Saturday is reasonably straightforward.  Dig a bit deeper, and the presentation highlights some of the serious issues facing us as we try to reconstruct our health care non-system here in the United States.

At heart (pardon the pun), the paper is reasonably straight forward: cancer specialists use drugs that can damage the heart.  What the researchers found is that those same specialists don’t do as well as they could when it comes to detecting and treating heart failure in those same cancer survivors who have received those same drugs.

The larger question is what are we going to do to address this issue and the quality of  all medical care we deliver and receive in the United States, when we don't have the strong commitment and the systems in place to get the job done? 

Have you ever wanted something for such a long time that when it finally arrived you found yourself terribly disappointed? 

Maybe that’s the best way I can summarize my feelings about two studies reported today in the New England Journal of Medicine on the topic of prostate cancer screening and whether or not it really makes a difference.

This must be the week for cancer screening stories and reports, some of which are clearly crafted to alarm people who read them or watch them.  A segment on this morning’s NBC Today Show is a case in point, along with a story posted on the show’s website. A report earlier this week about the “over diagnosis” of prostate cancer as a result of screening was another.

What was missing from these various presentations and reports is a sense of balance about who has said what, which organization has made what recommendation, and an honest commentary that is meant to inform rather than frighten.

An article and editorial in today’s edition of the Journal of the National Cancer Institute about prostate cancer screening highlight the differences between the messages of science and the expectations of the media and the public, and how the two intersect.

The end result is that the science message from the article may be converted into a bit more sensational story than suggested by the conclusions of the research.  After all, talking about science simply isn’t sexy.  Talking about how medical tests harm patients is a surefire way to capture the attention of the public.

The research, which is interesting and well done from a science point of view, deals with the difficulty we have getting our arms around the fundamental question of how many prostate cancers are diagnosed that would otherwise not cause a man harm or death.  This is what doctors call “over diagnosis.”

It’s fitting that during Colorectal Cancer Awareness Month there is an intense discussion in the medical and regulatory communities and elsewhere about whether or not we should offer Medicare patients the option of a new screening test for colorectal cancer (CRC).

The test is called CT colonography (CTC), or virtual colonoscopy.  In short, it is a CT scan that can find polyps and cancers in the colon with x-rays.

As of now, the odds are against coverage for this test by Medicare.  But there is still time for the Centers for Medicare and Medicaid Services (or CMS, which runs the Medicare program) to review comments from interested parties and perhaps reconsider its recent preliminary “non-coverage” decision.