A new study published in JAMA Oncology has identified a regional-level link between inappropriate low-risk prostate cancer and breast cancer imaging, which suggests the presence of certain regional factors that may be driving this association.
Study author Dr. Danil V. Makarov, of the New York University School of Medicine, NY, and colleagues believe their findings suggest that policymakers should increase their focus on improving the use health care resources by region, particularly in regions with high use of such resources.
According to the background of the study, past research has estimated that around 30% of resources spent on health care in the US do not improve patients’ care.
In order to improve the use of health care resources across the country, the American Board of Internal Medicine (ABIM) Foundation launched the “Choosing Wisely” initiative in 2012. The campaign aims to encourage health care providers and patients to make “smart and effective care choices.”
As part of this campaign, the American Society of Clinical Oncology have compiled a list of tests and procedures that could be used less frequently without negatively impacting patient care. Though reduced use of diagnostic imaging for low-risk breast and prostate cancers forms a part of this list, Dr. Makarov and colleagues say health care providers continue to use such imaging unnecessarily.
However, they point out that while research has indicated that the use of inappropriate imaging for low-risk breast and prostate cancers varies by region, there is limited information on what drives such use.
With a view to finding out more, the researchers analyzed 9,219 men with low-risk prostate cancer and 30,398 women with low-risk breast cancer from 84 hospital referral regions, who were identified from the Surveillance, Epidemiology and End Results (SEER)-Medicare linked database.
The team identified high rates of inappropriate imaging in patients, with 44.4% of men and 41.8% of women affected. Inappropriate imaging was most common among men aged 80-84 years and women aged 67-69 years.
Since breast cancer and prostate cancer affect different populations and treatment involves different specialists, an association between the two diseases should not be present.
However, the team found that regions with high rates of inappropriate breast cancer imaging also had high rates of inappropriate prostate cancer imaging. In other words, a man with low-risk prostate cancer was more likely to receive inappropriate imaging if he lived in an area with a high rate of inappropriate breast cancer imaging.
According to the researchers, these findings suggest that “regions with higher rates of inappropriate breast cancer imaging may have infrastructure (i.e., access to PET) or culture promoting imaging.”
Based on these findings, the authors say policymakers should consider regional-level factors when looking to improve the use of health care resources across the country. They add:
“Further research should be conducted to determine the causes of regional patterns of inappropriate imaging. Such research, including an evaluation of the clinicians and institutions performing these tests, might help optimize policy interventions aimed at improving the quality and lowering the cost of health care without decreasing access to care for those who need it.”
In an editorial linked to the study, Dr. Samuel Swisher-McClure and Dr. Justin Bekelman, of the University of Pennsylvania, PA, note that the findings from Dr. Makarov and colleagues provide further evidence that factors at regional level influence the use of health care resources.
“However,” they add, “it is important to distinguish the authors’ findings indicating inappropriate use of low-value care from the related but distinct issue of excess geographic variation in health care utilization.”
“Although the existence of excess variation in health care spending without improvement in patient outcomes suggests that inappropriate utilization may be a primary explanatory factor,” they continue, “prior studies have indicated that only a small proportion of observed geographic variation in health care spending can be explained by inappropriate use.”
Earlier this month, Medical News Today looked at a number of reviews published in The BMJ as part of its “too much medicine” campaign. Specifically, the reviews investigated whether the harms of overdiagnosis among men screened for aneurysm and women screened for breast cancer outweigh the benefits.