Thanks for sharing! This is an extremely important issue requiring a bright spotlight from medical leaders, quality/safety experts and patient advocacy groups. Since we spend the most in the world on healthcare yet are ranked 37th on basic health measures it is easy to conclude that more is not necessarily better. It's easy to see how rushing into "liquid biopsies" will evolve into a medical and financial disaster. Those with vested financial interest will leverage the superficial thinking and misunderstanding of "who wouldn't want to know about their cancer early?" to force the politicians and then CMS to reimburse these new tests.
This again raises the issue of is overdiagnosis a diagnostic error problem? It really seems impossible to separate the two missions. I agree that SIDM should weigh in on the dangers of overdiagnosis and screening without a grounded risk-benefit analysis. I hope the SIDM Board does develop a policy recommendation on this.
Thanks again for bringing this to the list!
Art Papier MD Chief Executive Officer
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
Historically, I think the most egregious examples came from the urology community on overuse of PSA (though I think AUA has been quite responsible on the topic in recent decades), and mammography, where I see more of a mixed record among breast surgeons and radiologists. Given that history, maybe it's inevitable that my own laboratory medicine community is being the bad guy now (in partnership with biotechs, investors, and sadly the ACS who I thought had turned the corner on this issue a few years back).
Since I just cast aspersions at (some) radiologists, I need to now atone by acknowledging the ways in which radiology professional societies criticized whole-body CT/MRI screening centers when they started to get popular about 20 years ago. That particular industry never really took off, maybe because it was largely direct-to-consumer, so insurance payments never followed. (And consumers ultimately didn't see the value of paying thousands out of pocket for something with no proven benefits.)