Though it has been well established that not all diagnostic tests are good for patients, the problem continues to grow. As a recent article in the New York Times reported, elderly men are being screened for prostate cancer at alarmingly high rates, despite recommendations from authorities voices in medicine.
In 2008, the United States Preventative Services Task Force found that screening tests for prostate cancer were not useful for elderly men, and that they could actually cause more harm than good. Prostate cancer is a slow-growing cancer that may never affect a person in his lifetime, especially if the man is over 70. Excessive testing makes healthcare more expensive, and lead to excessive worrying that turned in to unnecessary treatments for patients.
Studies continued to affirm the uselessness and harm of the tests, and in 2012, the task force recommended against all routine PSA tests (prostate-specific antigen blood test) for men of all ages.
However, studies have shown that 38% of men over 75 are still being screened through PSA tests, meaning about 2 million men over 75 are tested every year. These screenings can lead to false-positives and abnormal findings that result in lengthy and expensive unnecessary cancer treatments.
The tests themselves also come with risks. The test is completed through a biopsy that comes with the risk of pain, infection, and bleeding. Moreover, the tests are only able to detect cancer in about 30% to 40% of men with abnormal PSA levels.
The results of unnecessary PSA screening tests often lead to unneeded cancer treatment for men. About 60% of men with low-risk cancer choose to aggressively treat cancer with surgery or radiation, even if the procedures are not necessary. While leaving cancerous cells alone sounds like a bad idea, sometimes it causes less harm to the patient than trying to treat cancer. Most men with prostate cancer do not die from prostate cancer, but from other causes.
There are many reasons doctors order unnecessary diagnostic and screening tests, including:
- To make the patient feel more comfortable
- To be thorough, though doctors could always find another test to “make sure”
- To cover the doctor's tracks in case of a malpractice claim
- To gather more information, even if the diagnosis (or lack of diagnosis) is already clear
- To be convenient, like if the patient is already getting other tests done
But there is a line between the information doctors need to know and the information they might chase with unnecessary tests that cause harm to the patient. Small abnormalities are common in screening and diagnostic tests. If a patient has no significant risk factors for a disease, then many screenings and diagnostics should not be a part of their treatment plan because those small abnormalities turn into big treatment plans.
When unnecessary tests are multiplied across all diseases in all patients in the country, they add up to billions of wasted dollars for the health care system. In 2012 alone, over $132 million was spent on PSA tests.
The NYT reported that most men over 75 who received a PSA reported that their doctors had recommended the test. Most of the patients did not remember discussing any negative side effects of the test.
Doctors should be transparent with their patients about the reasons behind screening and diagnostic tests. Patients can also work to educate themselves about when tests are necessary, and when the risks of a test outweigh the benefits.