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Editorial: Reduce health costs by avoiding unhelpful tests

A government task force advises that most women

A government task force advises that most women do not need mammograms until their 50th birthday. Credit: June 2000 File / Jim McGuire

When we find medical tests like mammograms being performed more often than is necessary or wise, we must reduce the frequency. Paying for health care practices that help is expensive enough. Paying for ones that don't help, and even do harm, is a cost we cannot bear.

A study, released last week confirmed what scientists also said in 2009: Mammograms are not necessary until age 50 for most women. Women 50 and older should only have them every other year, not annually. And annual mammograms not only don't help most women between 50 and 74, they actually come close to doubling the number of false-positives women experience. False-positives often require further tests, like biopsies, that can create extreme anxiety. Frequent mammograms can also identify cancers growing so slowly they never would have caused the patient problems in her lifetime, resulting in unnecessary treatment.

There is, scientists agree, a cohort of women who should get annual screenings from age 40 on, mostly those with a gene mutation that puts them at high risk of breast cancer or family histories of the disease. Most women are not in these groups.

When an independent panel of health experts in preventive and primary care, appointed by the federal Department of Health and Human Services, reached this conclusion in 2009, it was lambasted by some advocacy groups. The recommendation of fewer screenings came from a government-appointed committee at a time when "death panels" was a catchphrase in the battle over health care reform, only adding to the furor.

Health care costs eat up about 18 percent of our gross domestic product. If they keep growing at the current rate, that figure will be 34 percent by 2040. The impact of that on our economy and our quality of life would be devastating.

Regardless of how we pay for health care, through Medicare or Medi-caid or the Affordable Care Act, through employer-based plans or out of our own pockets, the expense has to be controlled. One way to do that is by not spending money on tests that do more harm than good.

Mammograms aren't the only test performed too often because of faulty guidelines. This same government panel concluded in 2011 that healthy men, even those older than 50, should not receive annual prostate-specific antigen (PSA) blood tests to screen for prostate cancer because the test does not save lives overall and leads to tests and treatments that cause pain, impotence and incontinence. But, as with breast cancer, advocates involved in the prostate cancer cause fought the new guidelines.

When we think of health outcomes, it sounds good to say we'd spend any amount of money "to save just one life." In fact, it wouldn't make sense to spend billions of dollars on monthly cancer screenings, even if they did save a life or two. Beyond the expense, it wouldn't be worth the adverse effects, like hundreds of people dying in accidents on the way to and from the monthly examinations.

Numbers don't lie, but quite often, they also don't tell us what we want to hear. In the realm of health care, though, it's becoming increasingly necessary to listen to the numbers and weigh the cold, hard facts, even if the news they deliver discomfits us.