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"If you've had a normal mammogram and develop a new mass, don't ignore that. If you have a new symptom, those are things you don't want to ignore," Esserman said. "The public also has to understand that it's complicated and there are some cancers that are very slow-growing."
"The problem with our tests is they can see too much," added study author Dr. H. Gilbert Welch of Dartmouth and the Veterans Affairs Outcomes Group, who led the overdiagnosis study published last month. He says raising the threshold at which tests signal suspicion could help.
Welch also found diagnoses of thyroid cancer have more than doubled while the death rate remains unchanged, saying the new cases are almost entirely a small, low-risk type spotted with increasing medical scans.
Another issue is overscreening -- testing people who won't benefit, or testing too often.
Just on Monday, a survey of 950 doctors published in Archives of Internal Medicine found fewer than one-third follow national guidelines that say 30-somethings at low risk of cervical cancer need a Pap smear every three years instead of every year. They even too frequently screen women who tested free of the virus that causes this slow-growing tumor.
Worse, a 2004 study estimated nearly 10 million women had still received a Pap, which only checks for signs of cervical cancer, after losing their cervix to a hysterectomy for noncancerous reasons.
Then there are the "incidentalomas," a word recently coined to describe another growing problem. Get a chest CT scan to check for, say, heart disease. In addition to your arteries, it might also show your lungs -- and any dot or shadow leads to even more testing to rule out cancer.
That happened to Lichtenfeld, the cancer society expert, during his own heart CT two years ago. A follow-up scan six months later showed the small nodule on his lung wasn't growing, but did flag as suspicious additional tiny inflamed spots. Lichtenfeld knew those spots weren't very risky and refused doctors' recommendations for pricey additional tests.
However those overarching questions turn out, patients today face tough treatment choices -- and that's where "shared decision-making" programs come in. They help patients balance the right amount of care for their comfort level. Some, like Soviero, want less while others want more.
"What's underuse to one person might be overuse to another," said Jeff Belkora, who directs the decision-services program at UCSF's Breast Care Center.
UCSF's program sends newly diagnosed breast cancer patients a DVD to watch before that all-important first visit with a cancer specialist, to outline treatment options for their cancer stage and dispel myths. Patients also are offered a unique service, the aid of an intern to create a good list of questions to ask at that visit -- and then to attend with them, recording the doctor's answers so they won't forget.
Soviero, now 63, first used the program in 2000 and her right breast remains cancer-free, affirming her choice to avoid chemotherapy. Last year, a mammogram spotted a tiny, unrelated tumor in her other breast. She went through the program again, and her fears about another round of radiation were relieved. She chose the same care -- lumpectomy and radiation but no chemo.
"The hard part of making a decision is you never know. ... I was lucky. I made the right decision, but you only know that down the road, looking back," Soviero said.
UCSF Decision Services: http://www.decisionservices.ucsf.edu/
Foundation for Informed Medical Decision-Making:
Archives of Internal Medicine:
Journal of the National Cancer Institute: http://jnci.oxfordjournals.org/
Veterans Affairs Outcomes Group:
American Cancer Society:
Copyright 2010 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
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