Over-diagnosis: Medicare Preventive Services Don’t Always Make Sense For Everyone
Medicare covers most, or all, of the cost of many preventive services, like annual mammograms and PSA tests for prostate cancer. But the downside is that screenings often flag benign and slow-growing cancers that pose no risk to the patient. Ruling out a malignancy can be highly stressful and expensive, leading to more tests, biopsies and even treatment that can be harmful — especially in the oldest of patients.
Excessive and unnecessary services that are unlikely to be beneficial and which drive up healthcare costs for patients and Medicare are gaining new scrutiny from experts. “Over-diagnosis” is estimated to be the largest contributor to wasteful spending in U.S. health care. A recent national survey published on the website of the National Institutes of Health found that doctors reported that more than 20% of all medical care they provided was unnecessary, including 25% of tests and 22% of prescription medications.
In some cases, people are getting screened for tumors in organs they no longer have. In a study of women over 30, nearly two-thirds of those who had undergone a hysterectomy got at least one cervical cancer screening, according to a study in the JAMA Internal Medicine. Medicare Part B covers such screenings once every 24 months for all women, or once every 12 months for women at high risk. The U.S. Preventive Task Force, however, recommends against screening for cervical cancer in women older than age 65 “who have had adequate prior screening and who otherwise are not at risk for cervical cancer.”
A variety of experts including the American Cancer Society are recommending breast and prostate cancer screenings for only patients expected to live another 10 years or more. Medicare, however, covers a screening mammogram for women age 40 or older once every 12 months or a diagnostic mammogram when medically necessary. The U.S. Preventative Task Force recommends one mammogram every other year for women age 50 – 74. Yet according to a 2013 study in JAMA Internal Medicine, mammograms for women over the age of 75 cost Medicare more than $410 million a year.
Medicare covers prostate-specific antigen cancer screenings (PSA) for prostate cancer once every 12 months for all men over 50. But critics say that this test should only be used in cases where a patient has specific symptoms. In fact, the U.S. Preventative Task Force recommends against (PSA) based screening for prostate cancer. Prostate cancer screening in men over 75 costs Medicare at least $145 million a year according to a 2014 study in the journal Cancer.
Over-diagnosis can cause real harm if patients suffer major negative side - effects from follow-up procedures. If you have questions about cancer screening tests, talk to your doctor. If advanced age is a factor, it may be worth getting a second opinion.
Sources: “Overtreatment In the United States,” National Institute of Health, September 6, 2017. “Doing More Harm Than Good? Epidemic Of Screening Burdens Nations Older Patients,” Liz Szabo, Kaiser Health News, December 20, 2017.