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Among cancer patients on Medicare, the costs for medical scans have increased twice as fast as overall costs for cancer care, Duke University researchers report.

“There has been a significant increase in the utilization of imaging services for cancer patients since 1999, especially advanced imaging services such as CAT scans, MRI and PET scans — the most expensive studies,” said lead researcher Dr. Kevin A. Schulman, a professor of medicine and business administration and associate director of the Duke Clinical Research Institute.

Schulman noted that more scans do not necessarily result in better treatment or outcomes. Patients, he added, can play a role in limiting the number of unnecessary scans.

“It’s OK to ask your physicians why they are ordering an imaging test and how you might benefit from the result,” he said.

The Duke report is published in the April 28 issue of the Journal of the American Medical Association.

For the study, Schulman’s group collected data on imaging costs of 100,954 cancer patients on Medicare who were diagnosed with breast, lung, prostate or colon cancer, leukemia or lymphoma between 1999 and 2006.

The researchers found that while overall costs for treating these patients rose 2 percent to 5 percent a year, the cost for imaging scans increased between 5 percent and 10 percent.

Although the costs for imaging increased faster than costs for overall care, imaging costs make up only about 6 percent of Medicare costs for each patient, the researchers noted.

The most growth was seen in the number of PET scans. The average annual number of PET scans grew from 36 percent to 53 percent, but they still remain the least-used scanning technology. However, these scans are the most expensive, running as much as six times higher than CT scans.

When PET scans were first introduced, Medicare did not pay for them, but by 2005 about 50 percent of patients with lung cancer and lymphoma were getting one or more PET scans, Schulman noted.

In 1999, patients diagnosed with lung cancer had about 21 imaging scans during the first two years of treatment. By 2006, that had increased to 24.

The highest imaging costs were for patients with lung cancer and lymphoma, averaging $3,000 during the first two years of treatment, the researchers found.

In addition, bone density studies increased in popularity. In fact, the number of breast cancer patients getting bone density studies almost doubled by 2005, with about one-third of all patients receiving one or more scans.

Michael T. French, a professor of economics, epidemiology and public health at the University of Miami, isn’t surprised that these costs have gone up so dramatically.

“Imaging has advanced considerably in recent years,” he said. “So, it’s logical that it would be used more often, and along with the higher costs of increased use are the costs of improved technology.”

French thinks that some of the increased use of imaging is related to increased reimbursement and competitiveness among hospitals. “Is there excessive use of imaging to improve profits? Yes,” French said.

In addition, there is a defensive aspect to the increased use of imaging, French said. “If the technology is present and physicians don’t use it, then if something happens to the patient there is a possibility for a lawsuit,” he said.

The bottom-line question is how imaging is being used, French said. “It’s a question of whether it’s wasteful or whether it’s higher cost to produce better outcomes,” French said. “Right now, we don’t know what all this leads to in terms of better outcomes.”

A group representing the medical imaging industry believe they have an answer to that question, however.

The Access to Medical Imaging Coalition point to a recent study, conducted by Columbia University professor of business Frank Lichtenberg and based on data from the National Cancer Institute and Thomson Medstat. That study found that, “cancer imaging innovation accounted for 40 percent of the reduction in U.S. cancer deaths between 1996 and 2006, making it likely the largest single contributor to decreased cancer mortality during this time period,” according to a news release from the coalition.

“Given that previous researchers have equated a one percent reduction in cancer mortality to nearly $500 billion in health care savings per year,” the findings suggests a role for medical imaging in cutting health care costs, the group said.

SOURCES: Kevin A. Schulman, M.D., M.B.A., professor, medicine and business administration, and associate director, Duke Clinical Research Institute, Duke University, Durham, N.C.; Michael T. French, Ph.D., professor, economics, epidemiology and public health, University of Miami;

Cervical cancer screening intervals could be extended for women aged 30 and over if doctors used human papillomavirus (HPV) testing rather than smear tests, British scientists said on Wednesday.

Experts said research into different screening methods found that HPV tests were very accurate in picking up early signs of cervical cancer and detected more serious abnormalities than conventional smear tests in women aged 30 and over.

“Using HPV testing as the primary screening method for cervical cancer would not only mean women could be screened less often but it would also mean efficiency savings,” said Jack Cuzick, a professor of epidemiology at Queen Mary, University of London, who worked on the study.

Several companies, including Roche, Gen Probe Inc, Abbott and Qiagen make HPV tests.

HPV is the most common sexually transmitted infection in the world. There are more than 100 types of the virus, some of which cause only genital warts but others cervical cancer.

According to the World Health Organisation, cervical cancer is the second biggest cause of female cancer deaths worldwide with about 288,000 deaths each year.

Cervical screening programs are well established in many wealthy nations and immunization programs against HPV with vaccines such as Cervarix from GlaxoSmithKline and Gardasil from Merck & Co are also being rolled out.

Cuzick’s study, which was published in the British Journal of Cancer, involved 11,000 women in the UK. Two samples were taken from each woman and one analyzed using the conventional cytology method, while the other was sent for HPV testing.

ACCURACY

Cytology involves an analysis of cervical cells taken during a smear test.

The results showed that women with HPV negative results had a lower rate of developing pre-cancerous cells for at least six years compared with women who recorded a negative cytology result, showing that HPV testing was more accurate.

A second study conducted by Finnish scientists, published in the British Medical Journal, showed that HPV testing is also better than cytology at detecting severe pre-cancerous lesions.

In a telephone interview, Cuzick said the evidence now showed clearly that regular testing programs in all countries that conduct them should be swap to using HPV tests.

“There is now an overwhelming case for moving to HPV as the primary screening test,” he said. “If you have a test that gets it right the first time, you can also increase the gap between screens, saving doctors’ time.”

Current policy in Britain is to test using cytology every three years from age 30 to 50 and then every 5 years for older women. In the United States, smear tests are recommended every two years from age 21 to 30 and every three years beyond that.

Cervical cancer is a slow-growing cancer, which means that more accurate HPV screening would only need to be done about every five years to be effective, Cuzick said.

(Editing by Andrew Roche)

High-dose vitamin B therapy is dangerous for diabetics with kidney disease, and patients on this regimen should stop immediately, says a new study.

When the researchers began the study, they believed it would show that high-dose vitamin B therapy (folic acid, vitamin B6 and vitamin B12) would improve patients’ kidney function and reduce their risk of heart attack and stroke.

But it turned out that patients on high-dose vitamin B therapy had significant worsening of kidney function, and twice as many heart and stroke incidents as patients taking a placebo.

“Because B vitamins are water soluble, we suspect that while healthy people would excrete excess vitamins in urine, those with renal failure would not be able to do so, perhaps causing the adverse effects we have seen in this study,” Dr. David Spence, of the University of Western Ontario in Canada, said in a university news release.

“Vitamin B therapy may still be beneficial in people with normal kidney function, but this is clear evidence that high doses of vitamin B should not be given to those with kidney problems,” he added.

The study is published in the issue of the Journal of the American Medical Association.

More than 40 percent of people with diabetes develop kidney disease.