Is the US better at cancer screening than other countries?

Great Debates
1

I’ve recently started educating myself in force on the health care debate, taking special care to record all opinions and factoids from all sides to compare against each other. One thing that really surprised me, from those against single-payer health care, is the US’s impressive survival rates for cancer compared to England, Canada, etc. Just one metric, I know, but an important one.

Looking a little deeper, turns out the mortality rates for cancer are actually about the same across countries - it’s the incidence rate that’s much higher in the US, suggesting either we get a lot more cancer than Europeans, or we’re doing much better at screening. (Or is there another reason?)

Anyway, I’m wondering if the US really is much more proactive about cancer screening. Given that universal health care is often said to encourage regular checkups, this is a surprising thing to hear. Is there another reason?

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There is some evidence that the U.S. does extra screenings and such, on people who are not at significant risk, and finds cancers or lumps or nodes or whatever, and then does expensive treatments on them, “cures” the cancer (or finds it benign, or it goes into spontaneous remission, or disappears), and counts it as a cancer success. Most UHC countries have risk vs. reward screening practices, so they don’t detect the early, benign, or self-healing strangeness that exists in most human bodies. They probably also don’t detect the “wow, I didn’t know a woman/man this age could have this cancer” stuff, either. This could, therefore, be either good or bad. Even on House, the tv show, it claims that if they do a full-body CAT scan or MRI on the average human, they will find “perfectly normal” lumps, bumps, nodules, or growths that must then be investigated and treated, but aren’t actually dangerous. To what extent this is normal, I don’t know.

IANADoctor.

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The shortage of specialists in countries with UHC, and the waiting times required to get care, can’t be good for their cancer statistics. Cancer tends to progress.

That said there are diminishing returns to being at the cutting edge of any medical technology, you are going to get false positives and no doubt about it. By the same token, if you want to cut costs you will have to cut screening and early actions, and I’d rather whoever gets that mandate cut your care than mine.

4

Yet their statistics are just fine.

5

There has been a lot of debate in the US about whether the system has excessive amounts of screening and treatment for cancer at a cost to both the patient’s health and the bottom line.

The NYTimes had an articlewhich looked at some of the problems with cancer screenings:

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That’s an interesting and useful article, thanks. Interesting that there can be such a thing as too much screening.

athelas, as I said, the fact is that countries with UHC have mortality rates that are very similar to the US. More people per capita are diagnosed with cancer here, though. Simple math dictates that the US can therefore claim higher survivability rates, but the reason is the higher incidence, not better mortality. With minor variations, you’re equally likely to die from cancer in the US vs. any other advanced country.

Any other thoughts? (Come on people, I posted about health care in Great Debates!) :slight_smile:

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The differences in cancer survival between the U.S. and Europe are affected by a number of factors.

Availability of cancer screening appears greater in the U.S. for such tests as mammograms and Pap smears. It could be argued that many lesions picked up on such tests (and also prostate cancers discovered through PSA screening) are early-stage cancers or precancers and that if they’d gone undetected, a good number of them (i.e. low-grade prostatic adenocarcinomas and ductal carcinoma in situ of the breast) would not have progressed to deadly malignancies over the patient’s life span.

It gets more difficult to make the “overscreening” argument when it comes to carcinoma of the colon and rectum, where survival also is higher in the U.S. compared to Europe. And when survival is also significantly greater for cancers like melanoma, the idea that there are other systemic differences in care gains credence. From a Medscape article online (for some reason I can’t directly link to it but it comes up on a Google search):

*"August 22, 2007 — New reports from EUROCARE suggest that cancer care in Europe is improving and that the gaps between countries are narrowing. However, comparisons with US statistics suggest that cancer survival in Europe is still lagging behind the United States. The reports are published online August 21 in Lancet Oncology and scheduled for the September issue…
One of the reports compares the statistics from Europe with those from the United States and shows that for most solid tumors, survival rates were significantly higher in US patients than in European patients. This analysis, headed by Arduino Verdecchia, PhD, from the National Center for Epidemiology, Health Surveillance, and Promotion, in Rome, Italy, was based on the most recent data available. It involved about 6.7 million patients from 21 countries, who were diagnosed with cancer between 2000 and 2002.

The age-adjusted 5-year survival rates for all cancers combined was 47.3% for men and 55.8% for women, which is significantly lower than the estimates of 66.3% for men and 62.9% for women from the US Surveillance, Epidemiology, and End Results (SEER) program ( P < .001).

Survival was significantly higher in the United States for all solid tumors, except testicular, stomach, and soft-tissue cancer, the authors report. The greatest differences were seen in the major cancer sites: colon and rectum (56.2% in Europe vs 65.5% in the United States), breast (79.0% vs 90.1%), and prostate cancer (77.5% vs 99.3%), and this “probably represents differences in the timeliness of diagnosis,” they comment. That in turn stems from the more intensive screening for cancer carried out in the United States…The differences in survival are due to a variety of reasons, Dr. Verdecchia and colleagues write. They include factors related to cancer services — for example, organization, training, and skills of healthcare professionals; application of evidence-based guidelines; and investment in diagnostic and treatment facilities —as well as clinical factors, such as tumor stage and biology."*

Survival with cancer doesn’t just mean early diagnosis. It also encompasses timeliness of therapy and access to new drugs, where there are some differences between the U.S. and Europe.

A bit off the subject - you often hear that universal health care will save money because all the added cancer and other health screenings will pick up serious diseases earlier and we’ll be able to avoid radical surgeries and such. This will not happen. In the case of cancer screening, there will be tons of extra imaging studies and biopsies, all adding up to a vastly greater national health bill. We can avoid a fraction of this by smarter screening guidelines, but the bottom line is it’ll cost big bucks.

Jackmannii, M.D.

8

And your evidence for this is?

My wife had a benign breast tumor (ductal papilloma in situ) and they took it out in o time, biopsied it immediately and declared it benign. I saw no evidence of a shortage of specialists. I had a very slow and irregular heartbeat. Within a month, I had a 24 hour cardiogram (Halter device), a recommendation for a pacemaker and the pacemaker installed. In the US this would have happened only if had insurance and the insurer agreed to pay for it. Or I could pay for it. I guess I could’ve, but it was certainly better not to have to think about it.

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Could you share the data with us, please?

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Here’s the summary of what I found, mostly thanks to you fine people. :slight_smile:

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Screening is one thing, getting an insurance company to pay for treatment is another. A guy at my racketball club has lymphoma , for the 2nd time. The doctor ordered a scan. The insurance company over ruled and refused to pay for it. . He lost his job and expects to go bankrupt before it is over. He is 44 years old. The doctor wants the test to target the treatment better.