18 votes

Jump in cancer diagnoses at 65 years old implies many patients wait for Medicare to kick in before they seek care

4 comments

  1. joplin
    Link
    This is really depressing. A friend-of-a-friend just found out last week that he has a heart problem. When they did some scans to find out what was going wrong, they found he has stage 4 kidney...

    This is really depressing. A friend-of-a-friend just found out last week that he has a heart problem. When they did some scans to find out what was going wrong, they found he has stage 4 kidney cancer as well. He's an actor, so he doesn't have insurance as he does a lot of freelance work, but he can get it through one of the guilds he belongs to. The catch is he can't get it for 2 more weeks. The doctor has told him that he probably has about 2 weeks left before the cancer kills him. If he dies before the insurance kicks in, his wife, also an actor, will be stuck with his medical bills after losing her husband. It's unconscionable that we allow the sort of thing to happen in our country.

    13 votes
  2. teaearlgraycold
    Link
    I love analysis like this. You see a similar bias in test scores just above the required score to pass. Graders are willing to be a little lenient to move a few students from just barely falling...

    I love analysis like this. You see a similar bias in test scores just above the required score to pass. Graders are willing to be a little lenient to move a few students from just barely falling to barely passing. Broken bell curves tell interesting tales.

    5 votes
  3. spit-evil-olive-tips
    Link
    Direct link to the study (though the full text is behind a paywall): https://acsjournals.onlinelibrary.wiley.com/doi/abs/10.1002/cncr.33498

    Researchers analyzed data from hundreds of thousands of patients who were 61-69 years old and were diagnosed with lung, breast, colon or prostate cancer from 2004 to 2016. The patients, identified from a national database, included 134,991 with lung cancer, 175,558 with breast cancer, 62,721 with colon cancer and 238,823 with prostate cancer.

    There was a greater jump in lung, breast, colon and prostate cancer diagnoses at the transition from 64 to 65 than at all other age transitions, the research showed. Lung cancer rates showed a consistent increase of 3-4% each year for people aged 61 to 64, then at 65 that percentage doubled. The increase was even more pronounced in people with colon cancer, which showed an annual growth rate of just 1-2% in the years leading up to Medicare eligibility, then jumped to nearly 15% at 65. In the years following age 65, diagnosis rates declined for all cancers, the study found.

    Direct link to the study (though the full text is behind a paywall): https://acsjournals.onlinelibrary.wiley.com/doi/abs/10.1002/cncr.33498

    4 votes
  4. DanBC
    Link
    This is being framed as "people can't afford it so they wait until it's paid for them". Clearly this does happen across a range of healthcare in the US. The US manages to both withhold treatment...

    This is being framed as "people can't afford it so they wait until it's paid for them". Clearly this does happen across a range of healthcare in the US. The US manages to both withhold treatment from people who need it, and over-test and over-treat people who don't need it.

    Another way to look at this is to say that people when joining medicare are subjected to over-testing, which leads to over diagnosis and over treatment.

    The US is fixated on 5 year survival rates. These often aren't a useful measure. If you take a bunch people over the age of 65 and test them for thyroid cancer you're going to find a lot of cancer. Now you don't do anything at all to treat those cancers. You haven't affected when people die. You haven't affected what they die of. But now your 5 year survival rates have got better -- a lot of people lived for more than 5 years with thyroid cancer.

    And this example is a best case. If you do provide treatment you tend to find that you cause harm. People's quality of life decreases, some of them are injured by treatment, and some of them may even die from treatment. Your 5 year survival rates are good, but your all cause mortality is worse.

    We see this with prostate cancer, and prostate cancer is one of the cancers that showed a big jump in diagnosis from age 64 to age 65.

    https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/prostate-cancer-screening

    For men aged 55 to 69 years, the decision to undergo periodic prostate-specific antigen (PSA)-based screening for prostate cancer should be an individual one. Before deciding whether to be screened, men should have an opportunity to discuss the potential benefits and harms of screening with their clinician and to incorporate their values and preferences in the decision. Screening offers a small potential benefit of reducing the chance of death from prostate cancer in some men. However, many men will experience potential harms of screening, including false-positive results that require additional testing and possible prostate biopsy; overdiagnosis and overtreatment; and treatment complications, such as incontinence and erectile dysfunction. In determining whether this service is appropriate in individual cases, patients and clinicians should consider the balance of benefits and harms on the basis of family history, race/ethnicity, comorbid medical conditions, patient values about the benefits and harms of screening and treatment-specific outcomes, and other health needs. Clinicians should not screen men who do not express a preference for screening.

    https://www.hardingcenter.de/en/projects-and-collaborations/fact-boxes/early-detection-cancer

    https://www.hardingcenter.de/en/early-detection-of-cancer/early-detection-of-prostate-cancer-with-psa-testing

    3 votes