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Study Finds Too Many And Not Enough Scans

February 22, 2011
Written by: , Filed in: Abdominal Imaging, Diagnostic Imaging
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Too many low- and intermediate-risk prostate-cancer patients are getting expensive imaging—when actually none of them should—according to a study presented last week at the American Society of Clinical Oncology’s Genitourinary Cancers Symposium in Orlando.

At the same time, the study found, too few high-risk patients are getting the same scans—when actually all of them should.

Sandip Prasad, MD, a fellow in urologic oncology at the University of Chicago Medical Center, and the rest of his research team mined the government’s Surveillance Epidemiology and End Results-Medicare linked database. They looked at 2004-2005 data on 30,183 men diagnosed with prostate cancer.

Of those with low-risk cancer, 36 percent underwent MRI, CT, or PET imaging. “The chances of finding relevant disease outside the prostate in these patients on one of these scans is less than 1 percent,” Dr. Prasad said, as quoted by MedPage Today. “We think that the percentage of patients getting these exams should  be 0 percent.”

Similarly, he said intermediate-risk patients should not receive advanced scans, though 49 percent of them did.

On the other hand, he said, every patient diagnosed with high-risk prostate cancer should receive such scans. But only 61 percent of them did. “All of these men should have received the tests,” Dr. Prasad said. He continued:

Our numbers should have been 0 percent, 0 percent—and 100 percent for the high-risk patients. Instead, we saw 36 percent, 49 percent, and 61 percent. These are troubling figures.

Dr. Prasad said the tests he finds unnecessary may have cost taxpayers $35 million, even with Medicare’s low reimbursements. “When you consider that private insurers for younger men may reimburse at a higher rate,” he said, “the unnecessary expense may be far higher.”

The study found that overuse of imaging was most common among men who were older, black, wealthier, and living in rural areas. The least overuse was found for men with higher educations.

The most frequently ordered tests, the study found, were PET scans, typically used to determine whether distant metastases have occurred.

“I think there may be an aspect of defensive medicine as the reason for some of these tests,” Dr. Prasad said, “as well as an attempt by doctors to make sure they haven’t missed anything when prescribing definitive treatment.”

Related seminar: CT/MRI of the Abdomen and Pelvis

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