Sweden successfully reduced inappropriate prostate cancer imaging simply by sharing best-practice guidelines, a new report reveals. Cancer scans in Sweden dropped from 45 percent to just 3 percent for low-risk prostate cancer patients over ten years.
The country's methodology was simple. Local county governments and the National Prostate Cancer Register of Sweden worked together to promote appropriate imaging guidelines at industry meetings.
"They showed the practitioners what the imaging rates were at their hospitals and the hospitals in the area," said Danil Makarov, assistant professor of urology, population health and health policy at NYU School of Medicine, to DOTmed News. "It was kind of a shaming effect."
The expansion of prostate-specific antigen (PSA) screening
has increased the number of low-risk diseases caught and evaluated via imaging. While prostate cancer can develop into a fatal disease, it sometimes develops so slowly that it is unlikely to cause significant problems during a man's lifetime. That means treatment and screening aren't always appropriate for patients.
However, Makarov noted that it was likely for the best that 3 percent of low-risk patients were still scanned, as there are patients with certain symptoms who may benefit from scanning.
Though Sweden's intervention was successful overall, there was one unintended side effect. In addition to inappropriate screening, appropriate screening of high-risk patients also dropped, from 63 percent to 47 percent.
"Of course we would have liked to see that number go up to 100," said Makarov. "I would suspect that if you have an intervention that limited appropriate imaging, you should have something that would encourage appropriate imaging in the high-risk patients."
Makarov, who has a grant to study imaging trends in the U.S., hopes to replicate results stateside.
"One of the things that I think is most appealing about the Swedish system was this collaboration that they have in place between the professional societies and the county councils in Sweden," said Makarov. "The county councils rely on the professional organizations to set the policy agenda, and they trust them to go forward with this intervention. I think that's a very appealing partnership."
While Makarov said that the reimbursement model in the U.S. is certainly an imaging driver, he believes that the health care structure will not prevent the reduction of inappropriate imaging.
“I think we can tackle this problem,” he said. “The financial incentives are always there on a subconscious level at least, but personally, I think in this case it can be overcome.”