Is The U.s. Better At Treating Prostate Cancer?

by Zubin Jelveh | July 28, 2009

Gary Becker and Greg Mankiw point to this study to backup the idea that the European healthcare model and the greater regulation that comes with it isn't an improvement over the American system. From Becker:

A recent excellent unpublished study by Samuel Preston and Jessica Ho of the University of Pennsylvania compare mortality rates for breast and prostate cancer. These are two of the most common and deadly forms of cancer--in the United States prostate cancer is the second leading cause of male cancer deaths, and breast cancer is the leading cause of female cancer deaths. These forms of cancer also appear to be less sensitive to known attributes of diet and other kinds of non-medical behavior than are lung cancer and many other cancers.

These authors show that the fraction of men receiving a PSA test, which is a test developed about 25 years ago to detect the presence of prostate cancer, is far higher in the US than in Sweden, France, and other countries that are usually said to have better health delivery systems. Similarly, the fraction of women receiving a mammogram, a test developed about 30 years ago to detect breast cancer, is also much higher in the US. The US also more aggressively treats both these (and other) cancers with surgery, radiation, and chemotherapy than do other countries.

Preston and Hu show that this more aggressive detection and treatment were apparently effective in producing a better bottom line since death rates from breast and prostate cancer declined during the past 20 [years] by much more in the US than in 15 comparison countries of Europe and Japan.

But there's reason to think that these results are being oversold.

On the matter of prostate cancer and PSA testing, two recent studies published in the New England Journal of Medicine, which both used the "gold standard" in research design of randomization, found that PSA tests save few lives. This would mean that what Preston and Hu see in their data is mostly correlation (i.e., the people who tend to get PSAs are the people who would have survived in disproportionate numbers). And one reason to think this is what's really going on is that the regressions in the Preston and Hu study don't try to capture the effects of any other factors (beyond PSAs) that might lead to lower death rates in the U.S. In other words, they've identified, but not explained, a trend.

And in the case of breast cancer, it appears that government meddling has played at least a small role in driving down death rates. Here's a new paper from Marianne Bitler and Christopher Carpenter of UC Irvine:

The 1990s witnessed historic reductions in breast cancer mortality.  Striking increases in screening mammography—rates more than doubled from 1987 to 2000 among prime age women—are widely seen as responsible for  a substantial share of these improvements, though we know very little about what caused mammography rates to increase.  In this paper we show that state mandates requiring private insurers to cover mammography significantly contributed to the large increase  in screening rates.

Bitler and Carpenter estimate that mandates accounted for about 8 percent of the increase in mammographies. Other research has found that government-supported free screenings in poor areas have helped increase mammograms among Latinos and blacks. Now, I actually think there's something to be said for the leading-edge medicine used in the United States and that health care reform should do its best not to reduce incentives to innovate. But I'd be careful about using Preston and Hu's study to argue my case.

--Zubin Jelveh

Source URL: http://www.newrepublic.com//blog/the-stash/the-us-better-treating-prostate-cancer