Cancer: The Big C

Aliases: cancer

Cancer is an obvious choice for this month’s theme (economics); its costs are so great, they almost need no introduction. As the second leading cause of death in the US1, it has touched the lives of nearly every American. Obviously, the cost of cancer is incalculably high for the patient, but it does not stop there. The painful challenge of this disease extends outward, from family and friends to the medical professionals charged with combatting it.

While the emotional toll on doctors and nurses that work with cancer patients is impossible to measure, there are other, more quantifiable costs associated with their work. One is malpractice. Radiologists, who use imaging technologies (i.e. X-ray) to diagnose and treat illnesses such as cancer, have a high rate of malpractice claims, both in the US and abroad, and it’s increasing. This leap in litigation reflects both the inherent difficulties of radiology, and the rise in its use5. The majority of these suits are related to cancer cases; in Italy, over half of the diagnostic radiology claims between 1993 and 2005 concerned breast cancers and mammographic technique. The predicted rate of litigation against Italian radiologists is 10.5/1,000, which amounts to 1 claim per radiologists per 10 years of work4.

One survey of radiologists across three American states found that about half had a previous malpractice claim. The same study showed that malpractice suits have a negative psychological impact on the doctors involved; about 81% of respondents described the claim as very or extremely stressful. Nearly 1/3 (35.3%) had considered withdrawing from mammogram interpretation entirely because of malpractice concerns. The effects of these experiences spilled over into their practice. More than ¾ (76.4%) were concerned about the impact of claims on mammography practice, and over half (58.5%) indicated that their concern moderately to greatly increased their recommendations for breast biopsies (sampling cells or tissues), a more invasive diagnostic procedure. Yet, their fears may be overblown: the responding radiologists’ estimate of their future malpractice risk was much higher than the actual historical risk. And there doesn’t seem to be a downside for patients, as medical malpractice experience and concerns were not associated greater false-positive rates in cancer diagnosis3. Nonetheless, malpractice claims add another cost to cancer’s tally: the price of human error.

cancer
To err is human.

Cause: Although we think of cancer as one illness, it is really a category of ailment that encompasses a whole suite of diseases. But while there are a wide range of cancers, the fundamentals are the same. Cancer is caused by the development of uncontrollably dividing cells that can infiltrate and destroy normal body tissue. These abnormal cells are caused by a DNA mutation, which can be genetic (inherited), stimulated by the environmental (i.e. smoking or radiation), or a combination of the two. Cancer can spread throughout the body, but it takes time to develop, which is why most people are diagnosed after age 651. Men are most commonly affected by prostate cancer (128.3/10,000 men contract it), breast cancer is the most common type in women (122/10,000), and lung cancer has the highest fatality rate in both men (57.9/10,000) and women (37/10,000)2.

Consequence: Because there are so many forms of cancer, there are myriad symptoms, and they largely depend on the part of the body that is affected. Many are also symptoms of other less serious conditions. Some common symptoms include: a lump or area of thickening that can be felt under the skin, unexplained weight change, skin change, persistent cough, unexplained muscle or joint pain, fevers or night sweats, or indigestion or discomfort after eating1.

Cure: While there is no hard and fast cure, there are extensive treatment options. Treatments can be broken down into three types: primary (treatments that remove or kill cancer cells, i.e. surgery), adjuvant (treatments that kill cancer cells that might remain after primary treatment; i.e. chemotherapy or radiation), and palliative (treatments that relieve the side effects of other treatments or the cancer itself). Treatment options include surgery, chemotherapy (which uses drugs to kill cancerous cells), radiation therapy (which uses radiation, such as X-rays, to target cancerous cells), and hormone therapy, among others. Unfortunately, many cancer treatments have significant side effects, including: pain, fatigue, nausea, weight loss, diarrhea or constipation, and neurological or hormonal changes or issues. Palliative treatments include alternative medicine options, such as acupuncture or massage, which may offer some relief. As ever, prevention is key, and there are an abundance of screenings tests for cancer, ranging from physical to imaging to biopsy1.

References

  1. Cancer. Mayo Clinic. 2 January 2014. Web. 12 April 2015.
  1. Cancer prevention and control. Centers for Disease Control and Prevention. 6 April 2015. Web. 12 April 2015.
  1. Elmore, J.G., W.E. Barlow, G.R. Cutter, C.J. D’Orsi, R.E. Hendrick, L.A. Abraham, J.S. Fosse, & P.A. Carney. 2005. Does litigation influence medical practice? The influence of community radiologists’ medical malpractice perceptions and experience on screening mammography. Radiology, 236:37-46.
  1. Fileni, A., N. Magnavita, & L. Pescarini. 2009. Analysis of malpractice claims in mammography: a complex issue. La Radiologia Medica, 114:636-644.
  1. Magnavita, N., A. Fileni, P. Mirk, G. Magnavita, S. Ricci, & A. Cotroneo. 2013. Malpractice claims in interventional radiology: frequency, characteristics and protective measures. La Radiologia Medica, 118:504-517.

Image source: Creative Commons, http://www.bbc.com/news/health-29920157