Unconscious bias plays role in ovarian cancer screenings
In patient referrals, primary care physicians are influenced by their own connections to the disease, study suggests.
Not all cancer screenings are created equal. Some are recommended only for people whose risk is higher because of a family history or who have specific symptoms, because of the chance that false-positive results could lead to unnecessary, costly care.
Ovarian cancer screening is one of those. Many women have had unnecessary surgery after misleading results from a blood test of the CA 125 protein or from an ultrasound.
CA 125 is detected at higher than normal levels in an estimated 80 percent of women with ovarian cancer. Levels of the protein can also be elevated with other conditions, including uterine fibroids, endometriosis, liver disease, pelvic infections and other cancers (endometrial, breast, lung and pancreatic). Also, CA 125 levels are high in about 1 percent of healthy women.
An ultrasound cannot always differentiate between ovarian cancer and other, more treatable conditions such as an ovarian cyst and endometriosis.
Rationale for ovarian-cancer screenings is the topic of a study published in the Journal of Women’s Health. The research showed that primary-care physicians who have had cancer themselves or have had a family member or loved one with cancer were 17 percent more likely to act against established guidelines and recommend that low-risk women receive ovarian cancer screening.
The findings were based on a mail questionnaire to a random sample of 3,200 U.S. family physicians, general internists and obstetrician-gynecologists. The questionnaire included an examination vignette of a woman at average ovarian cancer risk and questions about cancer screening recommendations.
The study analyzed results from 497 physicians and weighted results to represent these physician groups nationally.
The survey was funded by the Centers for Disease Control and Prevention, and managed by senior author Laura-Mae Baldwin, professor of family medicine at the University of Washington School of Medicine. Baldwin’s goal is to identify and educate potentially noncompliant doctors to help ensure that patients more uniformly receive the best possible care.
“Some people may think, ‘What’s the harm in doing testing that’s not indicated?’ ”said lead author Margaret Ragland, a pulmonary critical care specialist at Colorado University Health University. “But if you find something, it can lead to further follow up, causing complications, cost, and anxiety.”