New Hampshire’s health insurance companies and the Foundation for Healthy Communities have released their latest guidelines for preventive medicine.
Many of the updates add new health screenings to routine care, but there are also some screenings that have been taken away.
They are related to detecting cancer.
This move might sound counterintuitive, but many health care providers agree, it can be good for your health.
New Hampshire Public Radio’s Kerry Grens reports.
Every two years, medical directors at Anthem, Cigna, and Harvard Pilgrim insurance companies sit down and draft a list of health conditions doctors should screen for.
The list is intended to help doctors keep up with the latest science.
And it also points out what the managed care companies have agreed to cover in their health plans.
Doctor Alan Freeman at Harvard Pilgrim says there have been several additions this year.
Freeman: One of the major ones which has come in this year certainly is childhood obesity.
Doctors are advised to measure patients’ body mass index routinely and offer intensive counseling for weight loss.
Freeman: We’ve really added also a couple of other things such as oral health and we’ve also added vision in children too. Both of these are relatively new this year because we’re trying to encompass the whole body.
Depression and osteoporosis are also new to the list of diagnostic screenings.
But there are also a few previously-advised procedures that have been taken off the list.
Breast exams and digital rectal exams are no longer recommended for breast and prostate cancer screening during routine physicals.
These guidelines have the support of the state’s Health and Human Services Department, the Medical Society, and the American Cancer Society.
They are based on federal preventive standards.
Doctor Freeman says that instead of routinely performing breast and rectal exams, doctors are encouraged to discuss the risks and benefits of these screens.
Freeman: With any procedure, whether it’s for screening for cancer or anything else, most physicians would agree you try not to harm the patient. Certainly, if you become very aggressive with screening in certain instances you might cause more harm than you cause good. For instance, as I say an example would be in prostatic cancer, if you have to have 20, 30 biopsies before you actually find the cancer. The question is, will it make a difference in the long term.
And the answer to that question, Freeman adds, is up for discussion.
Especially for prostate cancer.
According to the Centers for Disease Control, about one in six men will be diagnosed with prostate cancer, but for the vast majority of them it won’t be life threatening.
Kane: Are we discovering so many cancers that might in fact never develop into anything of concern?
Nancy Kane is the Chief Medical Officer for the American Cancer Society in New Hampshire.
Kane: Are we putting ourselves in a situation where people may be getting more treatment than is necessary, which could potentially lead to problems and side effects and disabilities of some kind?
Kane says that invasive biopsies, negative side effects from treatments, mental anguish, and financial burden must all be weighed against the risks of leaving a possible cancer undetected.
Kane recalls in the 90s the weight fell on cancer, and men were encouraged to get screened regardless of their medical history or risk factors.
But the US Preventive Services Task Force—a part of the Department of Health and Human Services—could not find sufficient evidence that mass screening reduced illness and death from prostate cancer.
Kane says there has since been a case by case approach to screening.
Kane: There’s been a pulling back in that field. Not saying, at all, and the American Cancer Society doesn’t say you should never have prostate screening, you should never have PSA. But the message has changed to say: if you are a 50 year old man, you should have a conversation with your doctor. What is the right time for you? And what tests should you be doing?
Breast exams have also been dropped from the routine care recommendations, because of the risk of false positives and unnecessary biopsies.
Doctor Gil Welch at Dartmouth Hitchcock has written a book about the risks of cancer screening.
He says that self-breast exams are not so much a danger as they just don’t work.
Welch: I don’t think the problem with self-breast exams was so much that it found a lot of unnecessary cancers. I think it was really that it lead women to be unduly anxious and yet didn’t provide any benefit.
The health insurance companies and healthcare organizations still recommend certain screenings for high risk patients.
And Dr Freeman at Harvard Pilgrim points out that for screens that are known to work well—like colonoscopy and mammogram—the guidelines are just as aggressive as ever.
He also adds that the recommendations, particularly for prostate screening, are not without controversy.
His advice: talk to your doctor.
SOQ
