two medical screening articles, one dippy, one interesting

[walkitout]

I'm sure their numbers are right, and I'll even stipulate without further investigation that their methods were no worse than average.

But come on. If you are a frail 80+ year old woman who no one is going to operate on anyway, and who already has a DNR, do you really need to be subjected to regular mammograms? This is just asinine.

http://www.reuters.com/article/healthNews/idUSCOL25307420080422

They're just trying to drum up more business.

"This study suggests that mammography benefits may have no age limit and that women should consider being screened on a regular basis, even into their 80s and possibly 90s, depending on their current health status," study chief Dr. Brian D. Badgwell, MD, of the University of Texas M.D. Anderson Cancer Center said in a written statement.

Well, Dr. Badgwell, you go out and have some sensitive bit squished to a point where you'd just about rather die than continue. Regularly. As an 80 year old. And tell me that torture does any real good for anyone.

The other article(s) is about Ritalin and related stimulant drugs to treat ADHD and similar in children. As one might expect, stimulant drugs + heart problems = bad.

http://ap.google.com/article/ALeqM5i-RXoYBMwOzwb2PVyFLkOi7oBrDgD906HE180

"Children should be screened for heart problems with an electrocardiogram before getting drugs like Ritalin to treat hyperactivity and attention-deficit disorder, the American Heart Association recommended Monday."

At least some of the coverage is doing a good job of pointing out the (in)obvious.

(1) Screening costs something (apparently $100 or so per ECG)
(2) False positives will create a cascade of more intrusive, expensive, possibly more dangerous tests that are emotionally extremely stressful for the patient and family.
(3) ECG screen may let enough cases through that screening ultimately has no net benefit.

No net benefit can happen several ways. The "cost" of the program may exceed the "value" of the patients saved. That's kind of yucky. But also, the added deaths due to additional unnecessary testing in the resulting false positive cascade (yes, virginia, people _do_ die from tests!) could conceivably equal or exceed the hypothetically avoided deaths from successful screening. And there's a chance this won't actually save anyone.

Comments

[ethelmay.livejournal.com]

Mammograms are vastly harder on some women than others. I've never had much problem with them (no worse than, say, a tetanus booster, though more time-consuming and embarrassing), and supposedly they get easier after menopause (actually, I wouldn't be *at all* surprised if mammograms are generally really, really easy to do on a typical 80-plus woman). Also he did say "depending on their current health status," which knocks out your frail-with-DNR-order example. He was probably talking about people like my stepmother, who had a much more serious operation at about eighty and soon went back to her usual program of dog walking, swimming, and tennis. But I'd worry about increasing total radiation exposure, which I thought was already a problem.

probably comes down to what-percentage-could-have-treatment

[walkitout]

For some, it might be just a lumpectomy, but for a lot, chemo and/or radiation might be involved, which is hard on anyone, but has to be harder even on a healthy 80 year old than someone decades younger.

I had _just_ heard a story from one of my brokers about a relative who _is_ 80, frail with a DNR who received a mammogram and all the caretakers and some of the relatives were so excited at how good the care was she was getting, while he was appalled.

It may be that more than 20% of women over 80 are healthy enough to survive treatment for breast cancer and therefore might possibly benefit from screening. But that's far from obvious to me.

This talks about the radiation risks, which are more serious premenopausal than postmenopausal:

http://www.preventcancer.com/patients/mammography/dangers.htm

It also mentions that overwhelming diagnostic facilities with healthy premenopausal women is dangerously delaying detection in women who are _referred_, which is fairly appalling all by itself.

It looks like the family practice docs and the college of preventive medicine are sticking to the 50+, as long as health would permit treatment if cancer is found.