In a recent You Docs column in my local newspaper, a woman asked about new ways to detect ovarian cancer. She went on to state, “Each year I ask for an internal pelvic exam and a CA-125 test. My mom died from breast cancer and my sister from ovarian cancer.”
The first part of Dr. Oz’s answer was, “. . . these are your two best options: the CA-125 blood test, which you’re smart to be getting, and a transvaginal ultrasound exam.” The rest of the response does mention there are false positives, but is mostly glowing in its recommendation that she get the tests. What’s wrong with this advice?
The United States Preventive Services Task Force gives ovarian cancer screening its worst grade, D, which means they believe the potential harms outweigh the potential benefits. Even the gynecologists state, “There is no good test to screen for cancer of the ovary. For this reason, routine testing for ovarian cancer is not recommended.”
It is possible that this woman is from a family who has one of the BRCA genes, which greatly increases the risk of ovarian, breast, and related cancers. The gynecologists recommend screening in these especially high-risk women, though there are no clinical trials proving it does any good.
The most important factor missing from Dr. Oz’s column was humility. He fell back on the typical ologist mantra that more expensive technology delivers better care, and early detection of cancers solves most of our problems. There was no acknowledgement that medical science has no proven way of impacting ovarian cancer other than the treatments prescribed for disease once its found.
Are these screening tests just another exercise in false hope? No one knows. I don’t know, Dr. Oz doesn’t know, the gynecologists don’t know, all because no study answers the question. One thing we can be sure of is even if technology extends a few high-risk women’s lives, the cost of healthcare rises if the tests are ordered. I’ve never seen him mention that fact in his columns.
It is hard to argue against the popular notion that we accomplish significant good and save countless lives by including an aggressive screening approach to healthcare. But how do you argue against the facts that various expert interpreters have called many screenings “nonproductive, unconvincing and possibly harmful”?
The only way I have been able to reconcile the relentless push for screenings is 1) they generate a sense of comfort in a medical-consumer society that wants to be comforted by the technological “wonders” we’re able to perform (followed by the expensive and wasteful procedures that do little to evidence economic merit) and 2) the screenings generate a lot of costly medical activities that bear no healthful fruits.
I maintain that our American healthcare consumer society has become addicted to being over-worried, over-diagnosed and over-treated because we’re inundated by information which leads us to believe that this is the right stuff to do.
Chris,
Thanks for your thoughts. I couldn’t have said it better.
I recently had a new patient whose previous doctor had ordered annual CA-125s, which were “borderline” every year. It took longer to convince her that the test was useless than it would have to oder the test, but when she left she was reassured that her risk was no higher as a result of her previous testing than the baseline low risk.
A lot of patients think it’s important to be “doing something”, even if that something is useless or harmful. This extends the whole lifespan from fetal monitoring (don’t get me started about maternal AFP testing or fetal heart rate monitoring), traverses all the useless screening tests we currently offer (think carotid screening in 90-year-olds) and goest through all of the super-intensive care we “offer” at the end of life to patients who would be better served off the ventilator.
My wife died December 2, 2010 at our home from Ovarian Cancer. She was misdiagnosed from January 2008 until September 2008 by a pair of doctors resulting in the cancer being in Stage 3c. She was not given the CA125 test during that entire time period. She wanted me to do what I can to increase awareness and spread the word about the CA125 blood test. Trials from M. D. Anderson and England have shown that using the test with trend analysis is an effective screening tool. We see pink everywhere but no teal and Ovarian Cancer is the fourth leading cause of death among women? Some of the things my wife was told during the 2008 period were: “Go home and do sit-ups.”, “You have IBS.”, “You have vaginal dryness.”, and “You may have diverticulitis.”. I have found very few women that have ever heard of the CA125 blood test. The only ones that have heard of it either have ovarian cancer or a family member does. In the past any CA125 number greater than 35 was considered not good. The first CA125 that my wife had was 5,500. I have been told by multiple doctors that the current standard is that when a woman has symptoms of Ovarian Cancer they try to rule out everything else before investigating Ovarian Cancer. By that time it is too late. It is absolutely necessary to find Ovarian Cancer in Stage One when the cancer is still contained in the ovaries. At that time it is 95% curable. After that the best that there can be hope for is remission for a period of time. The current chemo is not effective against the stem cells.
I am very glad that Dr. Oz is helping spread the word about the CA125 blood test. Some doctors have told me that they believe it will become a standard test in a few years as it should be. It can save the lives of hundreds of thousands of women from this terrible desease.
If you are only concerned about cost, the CA125 test is very inexpensive. The cost for the chemo, which is not very effective, is extremely expensive.
Mr. Graham,
Thank you for your heartfelt response. It raises many important points, so I decided to use it for this week’s post. My comments will follow yours.
Richard Young