Which cancer screenings should you skip? Consumer Reports weighs in

01/30/2013 4:13 PM

By Deborah Kotz, Globe Staff

Cancer 2.0. That’s what Consumer Reports has dubbed the new age of cancer screening where patients should be taking a good hard look at all those blood tests, X-rays, and ultrasounds before agreeing to be tested. The magazine released a report Wednesday rating screening tests by effectiveness and found that many aren’t worth the time, money, or risk.

(Yes, cancer screening tests have risks, leading to more invasive tests such as biopsies and treatments that aren’t ultimately lifesaving.)

Consumer Reports largely agreed with the assessments of the US Preventive Services Task Force -- a panel of independent primary care physicians convened by the federal government to evaluate screening tests and other preventive health measures. But the ratings also factored in the cost of the test, whether the cancer being screened for was prevalent or rare, and whether the test has benefits beyond screening for a particular cancer, according to Joel Keehn, senior editor at the magazine.

Colonoscopies, for example, can enable doctors to remove precancerous polyps during the screening to prevent them from developing into colon cancer. Along with colon cancer screening, cervical cancer screening -- such as the Pap smear -- and breast cancer screening via mammography were deemed to be the “most effective tests available”.

The ratings did distinguish by age, with mammograms getting a higher rating for women ages 50 to 74 and a lower rating for those who were younger and older than this age group.

Which cancer screenings got the thumbs down? Those for the following eight cancers: bladder, lung, oral, ovarian, prostate, pancreatic, skin, and testicular cancers. Consumer Reports recommended that people avoid those screenings since they’re not very effective for the general population.

But those at increased risk might still benefit. A CT imaging test, for example, in general carries more harms, such as radiation exposure and unnecessary biopsies, than benefits to screen for lung cancer -- though it can be beneficial for smokers who are at higher risk of getting lung cancer.

And while most of us don’t need a doctor to perform a visual exam of our skin to check for suspicious moles, those with a family history of melanoma or a personal history of precancerous moles should get this skin cancer screening. I might benefit from the skin check, too, because I’m heavily freckled.

Consumer Reports also highlighted the problem of variation among doctors in terms of whether or not they recommend useful screenings for cervical cancer or colon cancer.Massachusetts Health Quality Partners collected data last year that found a huge gap among large physician practices in the state. Within each practice, anywhere from 34 percent of the physicians up to 83 percent recommended breast screening to women who reached the appropriate age, and 23 percent to 87 percent of physicians in various practices recommended cervical cancer screening. Colon cancer screening referrals ranged from 45 percent to 95 percent.

Deborah Kotz can be reached at dkotz@globe.com. Follow her on Twitter @debkotz2.