I also notice that there is something about breast cancer that brings out the worst in medical decision making. Just over a week ago came the discovery that surgeons treating breast cancer had been removing more bits of women’s bodies than served any useful purpose. This time the story is that more than three times too many women in the U.S. get surgical biopsies rather than the cheaper, easier, less damaging needle biopsies that are recommended in almost all cases.
One article (which when reprinted seemed to account for most of the coverage of this news) suggested that the reason might be because the needle biopsy is typically performed by a radiologist, and surgeons do not like to lose the income by referring the patient to someone else (after all, when you are only making a mid-six-figure income, you really have to scrimp for every penny, even if it means needlessly disfiguring a few hundred trusting patients). A less disturbing speculation was simply that physicians were not keeping up with the research on what was optimal practice, though this is only slightly less disturbing. How difficult is it for someone to pick up on a simple guideline for what is one of his specialty’s most common activities? What else do they not know?
That, actually, is a point that was disappointingly overlooked. What else are cancer surgeons getting wrong and what will be the next piece of news about breast cancer treatment being too aggressive? (Will it be the realization that it is insane to harangue 40-year-old women to all get mammograms? Nah, that one will probably be a while longer.) On the other hand, the leading report on the topic did include a recognition that this is not just imperfect, but is outlandish and demands accountability. And the article pointed out that the surgeons doing these unnecessary surgeries might be “informing” patients of their choices in a biased way that favors the inferior option. This observation could be useful to the news-reading public, especially if they realize it generalizes.
So the reporting was generally good. But, as evidenced by there basically being one major story about it, the coverage was not so good. Unlike many of the fairly pointless, over-hyped stories I often report on, this seemed to be picked up only by the two major news outlets linked above and re-run in only a handful other print outlets. I could not find it in any broadcast media (I am sure it was there somewhere, but it certainly was not common or prominent). I suppose it might run tomorrow, though the first print story had already appeared yesterday, so perhaps not. Anyway, who would want to read a story (one of the twenty or so found in a Google news search) about these 300,000 unnecessary surgeries per year when you can instead read one of the (>500) stories about the 10,000 toddlers injured each year in cribs, or more precisely, mostly by climbing out of the cribs?
Don’t worry. If you would rather read about the latter, I plan to cover it next week.
Finally, since this was not the most entertaining of UNs I will direct anyone who follow the politics of tobacco harm reduction to today’s post about Obama quitting smoking on the THR blog – it is hilarious. (Paul Bergen wrote it, though I will claim credit for the “CSNa” bit.)