Unproven cancer technology drives health care costs

A paper in the recent issue of Archives of Internal Medicine perfectly illustrates how waste in health care can occur when industry and government ignore science.  Computer aided detection (CAD), a technology that digitally assists radiologists to review breast mammograms and find abnormalities that may be cancer, recently received congressional approval to be covered by Medicare. After members of congress lobbied hard to extend coverage, use of the technology has grown from around 5% to around 30%, and has resulted in an extra $20 million a year worth of mammography fees.

All this would represent worthwhile health care expense if the technology improved cancer detection and saved lives. But the best research indicates that it doesn't. In fact, a study of 200,000 mammograms published in the prestigious New England Journal of Medicine found that CAD increased false-positives, leading to 32% increase in follow-up mammograms and 20% increase in biopsies, without detecting any more cancers. A classic example of more health care (or more technology) not being better, and potentially being worse.

This is a common health care problem exacerbated by technology: We currently have gizmos that can detect the smallest potentially cancer-like abnormalities before we truly understand their natural history and whether they'll turn into something dangerous. Further testing and biopsies carries risks, including increased risk of cancer from imaging-related radiation. And recent research in the Journal of the National Cancer Institute suggests that up to 25% of breast cancers, 50% of lung cancers, and 60% of prostate cancers that are detected by screening may represent over-diagnosis in that they never would have evolved into a life threatening condition. While we don't necessarily know which cancers will evolve into killers, and which will not, those numbers are further evidence that the goal of health care technology shouldn't simply be to find more abnormalities, but rather to meaningfully extend life, quality of life and reduce disease burdens.

This latest study also shows that there may also be times when no technology can improve on human judgment and an experienced eye.