By Rochelle Sharpe and Elizabeth Lucas, iWatch News
Terry Waddell knew that her 87-year-old mother did not have long to live. The woman's organs were shutting down because of old age, she said, and her arthritic body had withered to 80 pounds.
So, when Waddell received a call about her mother's health, it was not what she expected. A visiting nurse had noticed a bit of blood between the frail woman's legs and wanted her screened for cervical cancer.
Waddell, of Houston, regrets that she took her mother for the test. She refused to let doctor's aides weigh her, she said, protesting that getting her mother out of her wheelchair was too arduous a process. Then came the actual exam, which she said "was painful to watch." Her mother struggled to open her legs wide enough for the procedure and then lay there, quietly crying.
"I blame myself for not stopping this," said Waddell, whose mother died two months later."It was totally unnecessary." Unnecessary, perhaps, but surprisingly common.
Cancer screening tests are vastly overused in the United States, with about 40% of Medicare spending on common preventive screenings regarded as medically unnecessary, an iWatch News investigation reveals. Millions of Americans get such tests more frequently than medically recommended or at times when they cannot gain any proven medical benefit, extracting an enormous financial toll on the nation's health care system. Doctors disregard scientific guidelines out of ignorance, fear of malpractice suits or for financial gain, as patients inundated by medical advertising clamor for extra tests.
In the frenzied hunt for cancer, the risks of the screenings also get overlooked. Besides producing anxiety, screening people for cancer can itself cause injuries -- even death -- or set off a cascade of expensive tests and treatments that can waste more money and create more problems.
The U.S. Preventive Services Task Force , a panel of independent medical experts, determines which screening tests offer more benefits than risks -- and who should get them. But even though the group's guidelines are considered the gold standard for medical care, its detailed recommendations are largely ignored, an iWatch News ' probe found, and the fiscal consequences are profound.
Medicare spent about $1.9 billion on common cancer screenings for people who were older than government-recommended age limits between 2003 and 2008, according to iWatch News ' examination of a six-year sample of Medicare billing records obtained by iWatch News and The Wall Street Journal. That's about 40% of everything that Medicare spent on breast, colon, prostate and cervical cancer screenings in that time period.
More than $31 million of that money was spent screening people who were in their 90s, the investigation showed.
Breast cancer screening guidelines were disregarded most frequently during this period, according to the iWatch News analysis. More than 22 million mammogram claims were submitted for women at or over the recommended limit of 75, the age when the task force says "evidence of benefits of mammography is lacking." (The number of claims cited for each test is greater than the number of procedures as hospitals and doctors both sometimes bill separately for each procedure. See methodology for more details.) Health care providers, meanwhile, billed Medicare for more than 10 million colon cancer screening claims and more than 6 million prostate cancer screening claims for people at or over the suggested upper age limit of 75.The task force gave these prostate screenings its strongest negative rating , actually discouraging their use.
For cervical cancer screenings, which the government panel says can usually stop at 65, over 80% of Medicare claims -- more than 13 million -- were for women who were 65 or older.
"This is a very bad way to expend money that is in short supply," says Dr. Virginia Moyer, chair of the Preventive Services Task Force, noting how harmful these tests can be. "There's human suffering involved."
Adds Clyde Behney, the Institute of Medicine's deputy executive officer: "It's a very sad testament to the system's workings." The Institute, part of the National Academy of Sciences, advises the government on health issues.
The government is sending mixed signals, medical experts say, with one agency discouraging older patients from getting preventive screening tests and another one paying for them -- and implicitly endorsing their use. All the while, the tests get promoted by corporations that have a financial interest in them being administered. Even some diaper companies get involved, experts say, noting that they can financially benefit from men getting medically questionable prostate tests and then winding up incontinent.
The $1.9 billion spent on excessive testing, meanwhile, represents only a fraction of how much these screenings actually cost the health care system, asserts Dr. H. Gilbert Welch , a Dartmouth medical professor, who says the most expensive part of screening involves the extensive battery of follow-up exams and procedures, such as biopsies.
"The test is chump change. It's all the stuff that happens afterward that costs a lot," says Welch, author of Overdiagnosed: Making People Sick in Pursuit of Health .
Welch calls overdiagnosis, the process of detecting medical abnormalities that will never harm patients' health, "the biggest problem posed by modern medicine."
iWatch News ' findings come in the midst of an intense national debate over the future of Medicare, the financially strapped health care program for seniors and the disabled. Republicans ignited a political firestorm earlier this year, proposing a radical overhaul of the entitlement program that would give seniors vouchers to buy private health insurance. Democrats condemned the plan and insisted that President Obama's landmark health care reform could control Medicare's rapidly escalating costs. Medicare costs are now being examined anew by the so-called Super Congress searching for long-term spending cuts.
If unnecessary screenings were cut, health care could actually be improved, says Dr. Mark Stoler , a medical professor at the University of Virginia. "We're brainwashed in America to think that more is better," he says.
But the "more is better" mindset is difficult to budge -- especially where Medicare is involved.
Every time
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By nature of the "obscene profiteering" of the parasites [insurers, lawyers, politicians] so the following: The start of coverage/payment for a client's "cancer" ONLY begins once the pathologic [diagnosis by Pathologists] is rendered [no insurance payments are made until the pathologic diagnosis is established - insurers avoid any workup costs - American "medicine" as a corporate business model!!] ....therefore, establishing the diagnosis of "cancer" IS the money "turning point" which helps drive excessive testing....A co-opted "medical" system whose priority is money-making.
Health and well being.....forgetaboutit!
It is not.
Why should the "rich" pay for other peoples healthcare?
I even have put stops to extravagant ongoing vet tests. I made the decision not to put my sick dog through that and my wonderful vet agreed. He will live out his 8 yr. old life until his diseases kill him-that cannot be cured. I just make the dog more comfortable. He is on only the one medication which has helped him. The rest I threw out-they made him worse. I monitor him like I would a human. I am not comparing a dog to a human, but at the end of the day it is common sense, knowlede and we must speak for those who cannot speak for themselves.
The biggest scam being perpetrated today is that Americans get good health care.
As we age, we are more likely to develop cancer with the odds being as high as 10% for certain cancers after reaching 70 or 80...so cancer screening is critical in this age group
Even if it is too late there is always palliative care which can ease suffering......
:-(