"The joint campaign by local county governments and the National Prostate Cancer Register [NPCR] of Sweden, which is an association of Swedish urologists, was incredibly effective at stamping out inappropriate imaging," lead author Danil V. Makarov, MD, from the NYU Langone Medical Center in New York City, told Medscape Medical News.
However, the campaign also decreased appropriate imaging in men with high-risk prostate cancer. The rate of appropriate screening in high-risk cancer patients fell from 63% to 43% over the same 10 years.
This is Medscapes summary of an article published 2 weeks ago in the Journal of the National Cancer Institute.
The AUA has recommended that patients with low stage prostate cancer do not have metastatic imaging tests for many years. The European community has similar guidelines. The Swedish government has linked itself with urologists and has dropped the rate of imaging from 45% to 3%. This is a positive finding since it saves cost in a rational way and prevents patients from having testing that sometimes leads to more testing and radiation exposure.
One troubling finding is that the patients who need imaging, the high risk patients have had a drop in their testing from 63% to 47%. If the reason why the testing for low risk patients dropped was that urologists were following guidelines more accurately, than there should have been a comparable increase in the appropriate testing of high risk prostate cancer patients. Since this didn’t happen, one has to question why there was a drop in both.
Once concern I have had about government involvement is that testing would be limited with the priority being to save health care expenditures.
As the affordable care act becomes implemented, we will need to see what changes doctors and patients will need to make.