Institute:Office of National Coordinator (ONC) Workforce Training Curriculum
Component:The Culture of Health Care
Unit:Evidence-Based Practice
Lecture:Phrasing the clinical question
Harm and prognosis
Slide content:Americans Love Screening Tests Despite Lack of Evidence Despite their limitations, screening tests for cancer are very popular with Americans (Schwartz, Woloshin , Fowler, & Welch, 2004) But cost of false-positive tests is substantial; in a study of screening for prostate, lung, colorectal, and ovarian cancer ( Lafata et al., 2004): 43% of sample had at least one false-positive test Increased medical spending in following year by over $1000 per person screened Controversies in recent years over screening for Breast cancer (Nelson et al., 2009; Kolata , 2009) Prostate cancer (Chou et al., 2011; Harris, 2011) 9
Slide notes:9 Americans love screening tests even though theres a lack of evidence for many of them. People are willing to have a test done even if a medical professional warns that the test may not be completely accurate or that theres no good treatment for a particular disease even if its detected early. A key problem with screening tests is that the cost of false-positive tests is substantial. A 2004 study looked at the costs associated with false-positive results of prostate, lung, colorectal, and ovarian cancer screening. This study found that forty-three percent of people screened had at least one false-positive test result. That false-positive test led to increased medical spending in the following year by over one-thousand dollars per person screened. In recent years, there have been major public controversies over screening tests. In 2009, a review of the evidence called into question the value of mammography screening for breast cancer in women under 50, raising concern that for this population, the screening test caused more harm than benefit. In 2011, a similar situation occurred for prostate cancer screening with prostate-specific antigen, or PSA [P-S-A], raising questions about whether the excess surgery and its complications in those with a disease never destined to spread beyond the prostate outweighed the benefits of those with a disease likely to be fatal. The references on this slide point to both scientific analyses as well as well-written articles about screening controversies.