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Inconclusive Medical Screenings May Spur Unnecessary Testing

Sunita Sah  “It’s not safe to have as many tests as you can and equate that to higher-quality care because the test itself may be risky or it could lead to further unnecessary, costly and aggressive testing,” said Sunita Sah, assistant professor of business ethics at Georgetown's McDonough School of Business.

August 8, 2013 – A recent study by a Georgetown business professor and medical doctor finds that unreliable medical screening tests with inconclusive results can lead to further examinations that may be unnecessary and potentially harmful.

Sunita Sah, assistant professor of business ethics at the McDonough School of Business, investigated whether receiving an inconclusive result from an unreliable prostate screening test (PSA) motivated men to undergo additional diagnostic measures.

She said the psychological uncertainty experienced after an inconclusive test result can lead to a phenomenon she calls “investigation momentum” – additional and potentially excessive diagnostic testing.

The professor focused on the PSA screening test because a U.S. Preventative Services Task Force found the test to be unreliable and there was controversy as to whether it actually reduced mortality. Sah wanted to investigate another potential downside to unreliable screening tests – the effects of receiving an inconclusive or ambiguous result.

Inconclusive PSA TestS

“The results of our study showed that significantly more men – 40 percent – said they would undergo a prostate biopsy if they received an inconclusive PSA test result, whereas only 25 percent of them opted for a biopsy when they had no PSA test result, even though the men were told that the inconclusive PSA result gave them no information on whether they had prostate cancer or not” the professor explains. “These results suggest that the ubiquitous use of unreliable screening tests may lead to consequences beyond the initial cost and patient anxiety of inconclusive results – they could also lead to investigation momentum.”

The study, “Investigation Momentum: The Relentless Pursuit to Resolve Uncertainty,” was published by the Journal of the American Medical Association: Internal Medicine in April.

Asking More Questions

Sah said both physicians and patients should think carefully about why they are offering or taking a screening test. “If a doctor orders a test, ask why they are ordering that test, what is your likelihood of having the disease, and what is the reliability of the test,” she said.

Although her study focused on prostate cancer testing, Sah said investigation momentum is likely not confined to reactions to an inconclusive PSA test and may result in other situations of ambiguity.

“Every medical test has a cost and a benefit to it,” she said. “It’s not safe to have as many tests as you can and equate that to higher-quality care because the test itself may be risky or it could lead to further unnecessary costly and aggressive testing.”

Redefinition of Cancer

A team that included National Cancer Institute researchers published a July 29 JAMA article online recommending that doctors redefine the word cancer and refrain from using it for certain illnesses and test results.

“The word ‘cancer’ often invokes the specter of an inexorably lethal process; however, cancers are heterogeneous and can follow multiple paths, not all of which progress to metastases and death, and include indolent disease that causes no harm during the patient’s lifetime,” the authors wrote.

Sah would like to do research on how a different medical label would affect the patient’s perception of the severity of their disease, the treatment recommendation and the patient’s final treatment decision.

“Certainly the recommendation to not use the word cancer in certain situations is prompted by a concern that many patients are having needless and potentially harmful or aggressive treatments for lesions that may never cause them harm,” Sah said. “Anxiety caused by being diagnosed with cancer or receiving an inconclusive medical test can often lead to further aggressive testing or overtreatment.”

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