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Shame on the American Cancer Society

  • 1.  Shame on the American Cancer Society

    Posted 10-07-2021 19:47
    Shame on the American Cancer Society.

    There is no better description for "multi-cancer early detection screenings" than a chance for profit from the public's fears about cancer and their faith in a technologic solution. "Detect cancer at early stages" is such an old, sad trope that, in the twenty-first century, knowingly avoids the question of whether people live better, longer lives from such detection. 

    Especially galling to me is the assertion that such tests will reduce cancer mortality disparities. Instead, the result will be to continue to siphon resources from actual causes of inequity -- structural racism, classism, an inherently inequitable national health care "system," and social determinants of health -- and give money to biotech and the consequent expensive, wasted health care "work up" of signals from such "multi-cancer early detection screenings."  With the implication that this will make Americans healthier.

    This is the exact opposite of the precautionary principle and will be done at scale. How dare they.

    Just my thoughts. I'd appreciate others. And I'd appreciate a robust, full-throated SIDM reproach of this hucksterism.

    Yours, 
    Steve


    https://us11.campaign-archive.com/?e=75ab50dfd1&u=f8609630ae206654824f897b6&id=296488c0d2

    SPONSOR CONTENT BY AMERICAN CANCER SOCIETY CANCER ACTION NETWORK

    Rachel only has three months… until her family vacation. Let's increase the odds against cancer.

    Scientists are developing a new way to test for multiple cancers at once, which could help detect cancer at earlier stages - when the patient may have more treatment options and a better prognosis. Multi-cancer early detection screenings could revolutionize cancer detection and help more seniors like Rachel rewrite their future by getting treatment early on. Once these tests are FDA-approved, Congress must help seniors access this breakthrough innovation. Tell Congress to support H.R. 1946/S. 1873Learn more.

    Multi-Cancer Early Detection Tests

    American Cancer Society Cancer Action Network remove preview
    Multi-Cancer Early Detection Tests
    Get one blood test. Detect up to 10, 20 or even more types of cancer. That is the potential for a new category of cancer early detection tests currently being developed and tested by scientists. A breakthrough like this could revolutionize the ability to detect cancer at its earliest, most treatable stages, including for dozens of cancers for which there is no current screening test.
    View this on American Cancer Society Cancer Action Network >

    Get one blood test. Detect up to 10, 20 or even more types of cancer.

    That is the potential for a new category of cancer early detection tests currently being developed and tested by scientists. A breakthrough like this could revolutionize the ability to detect cancer at its earliest, most treatable stages, including for dozens of cancers for which there is no current screening test.

    They call it a Multi-Cancer Early Detection (MCED) test. We call it an innovative and potentially game-changing advancement for cancer patients.

    Now we need to ensure that, if approved by the FDA, millions of people, especially older Americans at higher risk for cancer, will have the test covered by their health insurance plan. We are asking Congress to pass legislation that lays the groundwork for this to happen.

    Addressing Health Disparities Through Multi-Cancer Early Detection Tests

    American Cancer Society Cancer Action Network remove preview
    Addressing Health Disparities Through Multi-Cancer Early Detection Tests
    Multi-Cancer Screening Tests Can Catch More Cancers EarlyEarly screening for cancer is important because when detected at later stages, treatments are more limited, and outcomes are generally poorer. Newer, innovative multi-cancer screening technology has the potential to detect more cancers at earlier stages. Several private and academic entities are currently developing multi-cancer early detection blood-based tests.
    View this on American Cancer Society Cancer Action Network >

    Multi-Cancer Early Detection Screening Could Help Reduce Cancer Disparities

    Overall cancer mortality rates have been declining for more than two decades in the United States, but racial, socioeconomic, and geographic disparities persist. The availability of multi-cancer screening tests has the potential to address cancer mortality disparities by detecting more cancers earlier in more people. 

    Cancer disparities occur mostly because of barriers to high quality cancer prevention, early detection, and treatment due to inequities in employment, wealth, education, housing, and standards of living. 

    A simple blood test may be more accessible and acceptable to patients, thereby extending screening opportunities to traditionally underserved communities. Reducing cancer disparities can only be achieved if there is equitable access to the test in underserved communities, which Medicare coverage can help promote.

    New Ad Campaign Calls on Members of Congress to Support Legislation Aiming to Increase Early Cancer Detection

    American Cancer Society Cancer Action Network remove preview
    New Ad Campaign Calls on Members of Congress to Support Legislation Aiming to Increase Early Cancer Detection
    Washington, DC - The American Cancer Society Cancer Action Network (ACS CAN) launched a new advertising campaign this week highlighting its strong support for the Medicare Multi-Cancer Early Detection Screening Coverage Act (H.R. 1946/S. 1873), legislation that aims to improve access to new and innovative cancer screenings among Medicare beneficiaries to increase early cancer detection for more Americans.
    View this on American Cancer Society Cancer Action Network >



    ------------------------------
    Stephen Martin, MD EdM
    UMass Chan Medical School
    ------------------------------



  • 2.  RE: Shame on the American Cancer Society

    Posted 10-07-2021 19:51





  • 3.  RE: Shame on the American Cancer Society

    Posted 10-07-2021 19:53
    Thank you!  What a prescient, incisive post from last month.  FDA approval of this technology -- and the domino effect of expense that would follow -- would make Aduhelm look like penny candy.






  • 4.  RE: Shame on the American Cancer Society

    Posted 10-07-2021 20:39
    Good thinking Edward.

    With current knowledge what are five ranked tests that you and your colleagues on the list here think could be improved to enhance our diagnostic ability, while also reducing inequity?”

    Rob




  • 5.  RE: Shame on the American Cancer Society

    Posted 10-13-2021 18:47

    They're baaaa-ck ... now here to scare seniors:

    https://www.cancer.gov/news-events/cancer-currents-blog/2020/screening-cancer-older-adults-unnecessary

    This demographic is most likely to be overscreened and overdiagnosed and also sustain the greatest harms, as pointed out by the National Cancer Institute just last year:  

    https://www.cancer.gov/news-events/cancer-currents-blog/2020/screening-cancer-older-adults-unnecessary 

    SPONSOR CONTENT BY AMERICAN CANCER SOCIETY CANCER ACTION NETWORK

    How could multi-cancer early detection screenings revolutionize cancer treatment for seniors?

    Scientists are developing a new way to test for multiple cancers at once, which could help detect cancer at earlier stages, when the patient may have more treatment options and a better prognosis. Multi-cancer early detection screenings could help revolutionize cancer detection and help more seniors rewrite their future by getting cancer treatment early on. Once these tests are FDA-approved, Congress must help seniors access this breakthrough innovation. Tell Congress to support H.R. 1946/S. 1873.

    Get one blood test. Detect up to 10, 20 or even more types of cancer.

    That is the potential for a new category of cancer early detection tests currently being developed and tested by scientists. A breakthrough like this could revolutionize the ability to detect cancer at its earliest, most treatable stages, including for dozens of cancers for which there is no current screening test.

    They call it a Multi-Cancer Early Detection (MCED) test. We call it an innovative and potentially game-changing advancement for cancer patients.

    Now we need to ensure that, if approved by the FDA, millions of people, especially older Americans at higher risk for cancer, will have the test covered by their health insurance plan. We are asking Congress to pass legislation that lays the groundwork for this to happen.



    ------------------------------
    Stephen Martin, MD EdM
    UMass Chan Medical School
    ------------------------------



  • 6.  RE: Shame on the American Cancer Society

    Posted 10-14-2021 00:50
    There seems to be just an incredibly strong intuitive appeal to the idea of screening, combined with the fear factor of the big C. Frustrating but when even very smart people all fall victim to a cognitive trap like this, it's hard to come up with effective ways to counter that.

    Jordon Ellenberg is a U Wisc math professor who wrote a great book on improving mathematical reasoning in real life settings. Some of you might enjoy it. https://en.m.wikipedia.org/wiki/How_Not_to_Be_Wrong
    -Brian






  • 7.  RE: Shame on the American Cancer Society

    Posted 10-14-2021 09:35
    That is a terrific book!!  It is the most fun book I've ever read by a mathematician.

    Faulty reasoning, fear-driven over-screening, and an inability to live with uncertainty all dovetail, in my view, to create a toxic cocktail of false-positive tests, over-diagnosis, waste, and patient harm.

    All the best,

    Mike 


    Michael A. Bruno, M.D., M.S., F.A.C.R.  
    Professor of Radiology & Medicine

    Vice Chair for Quality & Patient Safety

    Chief, Division of Emergency Radiology

    Penn State Milton S. Hershey Medical Center
    ( (717) 531-8703  |  6 (717) 531-5737

    * mbruno@pennstatehealth.psu.edu  

    1571679014277





  • 8.  RE: Shame on the American Cancer Society

    Posted 10-14-2021 09:43
    Mike,

    To your excellent point, how do we define and measure faulty reasoning, fear, and uncertainty in both the physician and the patient so that we can address them in order to improve outcomes?

    Regards,

    Harry B. Burke, MD, PhD




  • 9.  RE: Shame on the American Cancer Society

    Posted 10-14-2021 09:52
    Thanks Harry.

    Faulty reasoning, fear and uncertainty are things that are very hard to measure.  But we can implement clinical diagnostic pathways, algorithms and guidelines which are based on experimental evidence.  So while we may not be able to reign in all of our fears, measure the uncertainty, and cure all examples of faulty reasoning (by education or any other means) we can absolutely address the "output" behaviors (such as test utilization) by means of following these guidelines.

    For some of these problems--such as deciding what tests are appropriate in any given clinical scenario--the guidelines already exist.  All we need to do is resist the urge to over-test beyond the guidelines and live with the inevitable uncertainty that we face.  This can be done without trying to quantify or measure that uncertainty.

    As Mark Graber pointed out, people are increasingly comfortable with following data-driven algorithms that suggest what items they might next want to buy from Amazon.com, etc., so perhaps we can all get more comfortable with following data-driven algorithms for deciding what tests to order, and whether a patient should be screened for some disease.

    Mike







  • 10.  RE: Shame on the American Cancer Society

    Posted 10-14-2021 10:38
    Mike,

    Of course you are right that validated clinical guidelines are helpful for physicians, but the other side of the coin is the fear and uncertainty of patients. We used to be able to assuage this by having a long term, trusted relationship with our patients. But that relationship no longer exists. How do we mitigate the fear and uncertainty of a patient who we have never seen before, and will never see again, on telehealth? Patients go on the internet, they want tests, they want treatments.

    Regards,

    Harry B. Burke, MD, PhD




  • 11.  RE: Shame on the American Cancer Society

    Posted 10-14-2021 12:24
    This is true; patient demand drives a lot of waste, and the internet (especially social media) is a huge source of fear and anxiety.  And no one, especially not patients, are inclined to accept the high level of uncertainty that exists. 

    The doctor-patient relationship probably was never all that good... we romanticize it a bit in our memories.  Kind of like how WWII veterans tend to remember the war fondly in retrospect, even though I'm quite certain that it was a horrific experience at the time.  But, as you point out, the doctor-patient relationship is now eroded into oblivion.  Single patient encounters, sometimes via a computer screen, with little hope of follow-up are becoming more of the norm.

    All I can say to this valid objection is that we physicians need to keep a unified front.  We can't let the patients "divide and conquer" us.  If we all adhere to the guidelines, it will eliminate the impetus for doctor-shopping.  Of course, this is probably more of a problem among the "worried well" than the truly ill.

    Mike







  • 12.  RE: Shame on the American Cancer Society

    Posted 10-14-2021 10:21
    I agree about the intuitive appeal of screening. The actual numbers are counter-intuitive and seem wonky to the public. That intuition is also reinforced by recommendations for mammography and colonoscopy.  Colonoscopy is a bit different because it is a direct test and therefore doesn't have the problem where less than perfect specificity leads to lots of false alarms. 
    Also, screening aligns with financial incentives of providers who aren't worried about the emotional impact of false alarms or the financial impact of over-testing and over-treating.

    ------------------------------
    John Brush
    Sentara Healthcare
    ------------------------------



  • 13.  RE: Shame on the American Cancer Society

    Posted 10-14-2021 12:25
    So true, John.

    One thing SIDM can contribute to the medical community on this issue is to help doctors become more sensitive to the issues of over-diagnosis, false-positive tests, over-screening and financial harm to our patients.

    Mike



    Michael A. Bruno, M.D., M.S., F.A.C.R.  
    Professor of Radiology & Medicine

    Vice Chair for Quality & Patient Safety

    Chief, Division of Emergency Radiology

    Penn State Milton S. Hershey Medical Center
    ( (717) 531-8703  |  6 (717) 531-5737

    * mbruno@pennstatehealth.psu.edu  

    1571679014277





  • 14.  RE: Shame on the American Cancer Society

    Posted 10-07-2021 22:23
    Sorry, but yes. If one's only tool is a hammer, the problems must all be nails.





  • 15.  RE: Shame on the American Cancer Society

    Posted 10-07-2021 22:58

    Thank you for a provocative post :)

    You're arguments are generally "on point" but please don't be so quick to completely denigrate a new technology just because it has not yet been proven to be "truth"...

    Firstly, we (and many others) have seen multiple cases of asymptomatic pregnant pts dxed with cancer as a result of the use of "cell free DNA" serum testing in pregnancy (which looks for genetic copy number variants that can impact fetal health and can "inadvertently" diagnose tumor DNA in the maternal blood stream); there's even an NIH sponsored ongoing cohort study that is examining this question in preg pts

    clearly there is a lot of active hype being generated about this new technology and clearly it's in the early stages of development and clearly we need appropriate science and research to demonstrate whether or not it will improve heath outcomes in the future....

    buttttt please don't throw out the baby with the bathwater (so to speak...)

    remember that in the famous Gartner "hype cycle", one moves from "technology trigger" to "peak of inflated expectations" to "trough of disillusionment" to "slope of enlightenment" and finally to the "plateau of productivity" 

    apparently the ACS has embraced that this new technology MAY result in improved health outcomes in the future; but clearly they (and SIDM) need to be careful about the messaging that is distributed to the medical community and the lay public

    the ad you posted was careful to use words like "potential", "in development", "may realize", "future"..... so they are thankfully using at least a modicum of caution...

    Secondly, there are many who believe that technology solutions WILL actually reduce health disparities in various medical disciplines for a variety of reasons (reducing access to care issues, eliminating human disparagement, etc etc); this has already been proven in my particular world of Obstetrics

    I, for one, hope that this or a similar DNA based technology helps improve health outcomes for cancer pts in the future :)

    respectfully

    Tom Westover
    Chief Maternal Fetal Medicine
    Capital Health
    Trenton NJ
    Associate Professor MFM
    Cooper Medical School
    Camden NJ






  • 16.  RE: Shame on the American Cancer Society

    Posted 10-07-2021 23:11
    Perhaps a bit of homework is needed to understand the impetus for the ACS email, which encourages support for a Senate bill that would allow CMS coverage for new (and future) early detection cancer screening tests.  As a 2-time breast cancer survivor, I appreciate any progress in this area.

    Denise Bockwoldt, PhD, APRN