Most medical centers routinely perform or require that breast tissue be sent to pathology for histologic examination. The authors of the article (referenced below) question whether this is useful when the breast tissue excised comes from an adolescent male with gynecomastia considering the benign nature of the condition.
Furthermore, the authors point out male breast cancer is rare and when it does occur it is most often in older males, not adolescent males:
In 2009, there were an estimated 1,910 new cases and 440 deaths related to male breast cancer, accounting for just 0.25% and 0.15% of all new cases of cancer and cancer deaths for males in the entire United States, respectively, with historical cohorts demonstrating that the peak incidence of male breast cancer occurs at approximately 71 years of age. More significantly, breast cancer becomes increasingly uncommon among younger age groups.
To look at the issue, the authors did a retrospective chart review of their patients younger than 21 years of age who had undergone subcutaneous mastectomy for gynecomastia between 1999 and 2010. A review of the literature was done, as was an informal survey of major children’s hospitals regarding their practice of histologic examination for adolescent gynecomastia. Read more »
*This blog post was originally published at Suture for a Living*
Take medical uncertainty. Add financial incentive to treat. Voila! Increased utilization. Now take away financial incentive to treat. Guess what you get?
MedPageToday explains, in the case of hormone therapy for prostate cancer:
Medicare accomplished what clinical guidelines and evidence-based medicine couldn’t: it reduced unnecessary use of androgen deprivation therapy (ADT) in prostate cancer.
Inappropriate use decreased by almost 30% from 2003 to 2005, following enactment of the Medicare Modernization Act, which lowered physician reimbursement for ADT. Appropriate use of ADT did not change during the same time period, according to an article in the Nov. 4 issue of the New England Journal of Medicine.
“Our findings suggest that reductions in reimbursement may influence the delivery of care in a potentially beneficial way, with even the modest [reimbursement] changes in 2004 associated with a substantial decrease in the use of inappropriate therapy,” Vahakn B. Shahinian, MD, of the University of Michigan in Ann Arbor, and co-authors wrote in conclusion.
“The corollary is that reimbursement policies should be carefully considered to avoid providing incentives for care for which no clear benefit has been established. The extreme profitability of the use of gonadotropin-releasing hormone (GnRH) agonists during the 1990s probably contributed to the rapid growth in the use of ADT for indications that were not evidence-based.”
*This blog post was originally published at Gary Schwitzer's HealthNewsReview Blog*
One of the blogs I read by Maggie Mahar pointed out a new study that found that 26 percent of kids under age 19 are now taking prescription drugs for a chronic condition. The drugs include asthma medication, anti-psychotics, diabetes drugs, anti-hypertensives, and heartburn medications.
According to the Medco study (the largest pharmacy benefit manager), the incidence of type-2 diabetes increased over 150 percent in children between 2001 and 2009. This is staggering. Children are supposed to be healthy and active, not tied to a regimen of pills. Read more »
*This blog post was originally published at EverythingHealth*
In a recent article, the editors of the Archives of Internal Medicine make the case that too much unneeded care is being delivered in physician’s offices these days. According to the authors, “patient expectations” are a leading cause of this costly problem.
Their solution? Get physicians to share with patients the “evidence” for why their requests are crazy, wrong, ill-informed or just plain stupid. But getting patients to buy into the “less is more” argument is a daunting task as most physicians already know. The problem is complicated by the fact that patients have a lot good reasons for not buying it. Read more »
*This blog post was originally published at Mind The Gap*