Cost containment in health care: Patient attitudes toward overdiagnosis give me hope

False positives from cancer screening tests cause unwarranted stress to patients, drive up health care costs, and can result in physical harm from invasive follow-up or needless treatment. A new study in JAMA Internal Medicine, as described on Auntminnie (Doctors are not informing patients of overdiagnosis risk), gives me hope that attempts to reduce overdiagnosis have a chance of success if framed well.

Conventional wisdom is that more screening is better --that it's good to have a test just to be on the safe side. People have stories about friends and relatives who didn't get screened, got cancer and died. That --plus a fear of "rationing"-- explains why there is such strong pushback against recommendations to reduce routine screening for breast cancer and prostate cancer. But rarely do we hear about people who were diagnosed with and treated for cancers they didn't have or that would never progress even though it is incredibly common.

The JAMA article reports on a survey of people aged 50 to 69, which asked about whether their doctors had informed them about overdiagnosis and overtreatment and about how much they would be willing to tolerate such overdiagnosis and overtreatment. I wasn't at all surprised to read that almost no one (<10% of the sample) was informed by their doctors. I was more surprised that people were so intolerant of screening's limitations.

Fifty-one percent of the participants said they would not start a screening protocol that resulted in more than one overtreated person per one life saved from cancer death, they wrote. But 58.9% said they would continue to be screened once they had started, even if they learned that the protocol resulted in 10 overtreated people per one life saved.

One of the most startling findings was that 69% of the participants indicated they would not start screening if overdiagnosis rates were more than 10 cases per one life saved, according to [the authors].

"The results of the present study indicate that physicians' counseling on screening does not meet patients' standards," they wrote. "Most individuals desired information about screening harms, which was not given, and attested that this knowledge would matter to them."

There's a long and winding path from these findings to a more rational screening and treatment regime, and the results of the survey are far from definitive. But this is one of the most encouraging pieces I've read in a long time because it suggests patients are ready to play a more active role in their health care, and that such engagement will tend to lead to lower costs and better outcomes rather than an increased demand for services.

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By David E. Williams of the Health Business Group.