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Premier Patient Health Care – Bending the Cancer Cost Curve

Welcome to the new Premier Patient Health Care bi-monthly publication Bending the Cancer Cost Curve where we will focus on ways to bend the high cost of cancer care and add value to your adult and Medicare-aged patient population.  Each release we will detail ways to positively affect shared savings and increase patient satisfaction through various channels that are already available as a member of the Premier Patient Health Care ACO and through your preferred partners, like Choice Cancer Care.

Our first edition is dedicated to the importance of preventative screening and early detection.

As physicians, we know that earlier detection of cancers greatly increases patient options for successful treatment. There are two components of early detection of cancer: patient education to promote early diagnosis and routine screening.  Today we are going to focus on routine screening.

The Right Screening at the Right Time

The two most common cancers among our patient population are Breast and Prostate.  Each have very distinct guidelines for screening.  Recently, the stated recommendations have drawn controversy and each set of guidelines have been debated by practicing physicians and the U.S. Preventive Services Task Force Services (USPSTF).  Let’s take a look at each.

Breast Cancer

Breast Cancer Screening per the American Cancer Society & the American College of Obstetricians and Gynecologists (ACOG):

  • ACS: Women ages 40 to 44 should have the choice to start annual breast cancer screening with mammograms (x-rays of the breast) if they wish to do so.
  • ACS: Women age 45 to 54 should get mammograms every year.
  • ACOG: Women age 40 to 54 should get mammograms every year.
  • Women 55 and older should switch to mammograms every 2 years, or can continue yearly screening.
  • Screening should continue as long as a woman is in good health and is expected to live 10 more years or longer.

Breast Cancer Screening per the U.S. Preventive Services Task Force Services (USPSTF):

  • Women age 50 to 75 should get mammograms every two years.
  • The USPSTF concluded that there is insufficient evidence to recommend for or against screening women 75 or older.
  • Women ages 40-49 attain less benefit with more risk and those who place a higher value on the potential benefit than the potential harms may choose to initiate screening mammography every two years between ages 40 and 49.

“Nobody is arguing that fewer women won’t die if they get mammograms at 40, and nobody is arguing there aren’t harms that come along with starting that early,” says Therese Bevers, MD, medical director of the Cancer Prevention Center at the University of Texas M.D. Anderson Cancer Center.

The upside at starting at 40 is simply put, “You’re less likely to die of breast cancer,” says Bevers, who chairs the National Comprehensive Cancer Network’s Breast Cancer Screening and Diagnosis Guideline Panel.

Prostate Cancer

Prostate Cancer (PSA) Screening per the American Cancer Society:

  • Age 50 for men who are at average risk of prostate cancer and have a life expectancy of at least 10 more years.
  • Age 45 for men at high risk of developing prostate cancer. This includes African-Americans and men who have a first-degree relative (father, brother, or son) diagnosed with prostate cancer at an early age (younger than 65).
  • Age 40 for men at even higher risk (those with more than one first-degree relative who had prostate cancer at an early age).

Prostate Cancer (PSA) Screening per the U.S. Preventive Services Task Force Services (USPSTF)

  • The USPSTF recommends that regardless of age, men without symptoms should not routinely have the prostate-specific antigen (PSA) blood test to screen for prostate cancer.

Since the USPSTF came out against routine PSA tests in 2012, we have seen the number of men who were screened drop 25% or more in successive years.  Recently a study published in Prostate Cancer and Prostatic Diseases, a journal from Nature, focused on an increase of advanced prostate cancer.

The analysis showed the largest increase was seen among men 55 to 69 years old. That age group saw a 92 percent surge in cases in the past decade, from 702 new cases in 2004 to 1,345 in 2013. This sharp uptick is particularly troubling, the authors said, because men in this age group are believed to benefit most from prostate cancer screening with the PSA (prostate-specific antigen) blood test and early treatment.

“If I were a patient, I would want to be vigilant. I firmly believe that PSA screening and rectal exams save lives,” senior study author Dr. Edward Schaeffer, chair of urology at Northwestern University Feinberg School of Medicine and Northwestern Medicine, said in a statement.

Our Take

“As doctors, we are trained to ask questions.  We look at each patient’s individual needs and always do what is in their best interest, “states Dr. Amelia Tower, Breast Surgical Oncologist of Choice Cancer Care.  “Putting our head in the sand shouldn’t be the answer.  It certainly isn’t part of the Hippocratic Oath. Professional and routine screening is both important and meaningful.  We should use the tools that are available.”

As practicing oncologists, our recommendation is to screen your patients routinely and regularly.  Earlier detection routinely leads to easier treatment paths for our patients, and to cost savings felt throughout the entire system.  In addition, early detection directly increases favorable outcomes and leads to increased patient satisfaction and, most importantly, to healthier patients.

Choice Cancer Care is a team of highly trained medical professionals who care deeply about our patients.  We know that we have a responsibility to practice excellent medicine in a compassionate fashion.  We are your ACO preferred partner and practice outpatient oncology care in a cost effective manner – with patient satisfaction at our core.  

If you have a patient with an elevated PSA, abnormal mammogram, a suspicion of cancer, or a diagnosis of cancer – please contact one of our Clinical Care Coordinators at 214.537.1595.  We are online at:  www.ChoiceCancerCare.com.

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