Two things of interest in the news today regarding cancer screening and they are both related. On is that a study published in the Journal of General Internal Medicine reported that only 25% of primary care doctors do all of the necessary steps in testing for colon cancer by finding occult blood in their patient’s stool. Problems reported included using the wrong method of testing, using outdated testing methods, not knowing how to handle a positive results, and not identifying those patients who do not go for the study. The good news is that the physicians are doing a better job than they have been.

The second article is one about breast cancer. David Vitter, the Senator from Louisiana who seems to be fixated on woman’s issues (or at least women) has called for Secretary Sebelius to require the Agency for Healthcare Research and Quality, or AHRQ, to remove the guidelines for breast cancer screening promulgated by the US Preventive Services Task Force from its website. Vitter also urged Sebelius to make AHRQ and all other agencies under her authority cease promotion of the recommendations. The Academy of Family Physicians wrote a letter in support of evidence based screening and the promulgation of evidence based standards,

The problems with screening people effectively are illustrated above. Colon cancer screening is a complex process which is “assigned” to the primary care office without adequate reimbursement. In order to develop the infrastructure that facilitates such testing, we need to increase the payment amount and improve the method of payment for primary care physicians. The problems with breast cancer guideline illustrate a lack of consensus over what should be happening. As you can tell, there are strong feelings on the part of all concerned about screening, and poor understanding of the limits of screening. Turns out you can hurt someone by screening as well. It is my belief that we would be better off with clear, conservative, evidence based screening guidelines that we can set our offices up to facilitate rather than trying to please everyone.