Top Five Cancer Tests and Treatments to Reconsider

Patients facing a cancer diagnosis deal with anxiety about the future, not feeling well and the high cost of care. That’s why the American Society of Clinical Oncology took a careful look at which tests and treatments oncologists are ordering that aren’t supported by evidence they help patients live longer and, in fact, could even be harmful.

“The issue is that many of the things we do are based on things somebody thinks are best practice and, often, there are not data to support their use,” says Kathleen A. Cooney, M.D., chief of the division of hematology/oncology at the U-M Medical School. “Excessive use of testing without adequate data can be dangerous to patients.”

The ASCO study was conducted as part of a national effort called Choosing Wisely® that challenged the medical community at large to identify five practices that are expensive, routinely used and for which there is insufficient proof the practice helps patients.

“These tests and treatment options should not be considered unless a patient and provider have worked together to discuss options,” she says. “The Top Five List doesn’t trump a clinical assessment. Hopefully this list will help stimulate dialogues about individual goals of cancer treatment and appropriate diagnostic testing and follow up.”

ASCO Top Five list for oncology*:

  1. Cancer directed therapy for solid tumor patients with little or no benefit from prior treatment.
  2. PET, CT and radionuclide bone scans in low-risk prostate cancer patients.
  3. PET, CT and radionuclide bone scans in low-risk breast cancer patients.
  4. Surveillance testing and imaging for breast cancer survivors with no symptoms
  5. White cell-stimulating factors for primary prevention of fever/infection associated with neutropenia (a low number of a type of white blood cells) in low-risk patients.

*Visit the Journal of Clinical Oncology for details on the summarized list above.


Researchers find first major gene mutation associated with hereditary prostate cancer risk

After a 20-year quest to find a genetic driver for prostate cancer that strikes men at younger ages and runs in families, researchers have identified a rare, inherited mutation linked to a significantly higher risk of the disease.

Kathleen Cooney, M.D.

Kathleen Cooney, M.D.

A report on the discovery, published in the January 12, 2012 issue of the New England Journal of Medicine, was led by investigators at the Johns Hopkins University School of Medicine and the University of Michigan Health System. The research team found that men who inherit this mutation have a 10 to 20 times higher risk of developing prostate cancer.

While accounting for only a small fraction of all prostate cancer cases, the discovery may provide important clues about how this common cancer develops and help to identify a subset of men who might benefit from additional or earlier screening. This year, an estimated 240,000 men in the United States will be diagnosed with prostate cancer.

“This is the first major genetic variant associated with inherited prostate cancer,” says Kathleen A. Cooney, M.D., professor of internal medicine and urology at the U-M Medical School, one of the study’s two senior authors. Continue reading