DCIS & Cost

The latest article - the link is below - is entitled: DCIS Score Fails Cost-Effectiveness Test. 
This is my somewhat political rant. 
This study looks at whether the Oncotype Dx test is cost effective.  I'm pretty smart, but the complexity of this studies' details is pretty extreme.  The Oncotype Test is expensive (about $3,400) and provides scores that stratify risk of recurrence and the value of treatment with radiation.  The test looks at an individuals' genes.
I think the upshot of the study, linked below, is that small dcis should not be treated with radiation and large/high grade should be treated with radiation.  Reading between the lines, I think the study is also implying, woman, just take your doctors' recommendations.

http://www.medscape.com/viewarticle/868827

I take issue with this study.  Women with dcis see at least three specialists - a surgeon, an oncologist and a radiation oncologist.  Sometimes there is a conference among the specialists reviewing the patient's presentation.  Sometimes a woman gets one consistent treatment recommendation from the team.  Sometimes that recommendation is clear cut, sometimes not.  Presuming that the lesion has been  surgically removed and identified as dcis, there are then treatment choices: mastectomy, radiation and adjuvant hormone therapy.  Every responsible source will say that dcis is heterogeneous, meaning it is a very diverse and different set of circumstances. 

So, a woman has to (and should) process a huge amount of information.  Or simply accept a recommendation and follow it.  Otherwise, the information includes what the doctors say and the vast amount of information available on the web.  There is no absolute right answer and each choice has bad side effects.  There are no guarantees - there are always recurrence risks, even a little bit with mastectomy!

So, if the Oncotype Test can reduce some women's choice of radiation (and the accompanying side effects) or reduce their anxiety over risk of recurrence, the test IS cost effective.

Similarly, the new guideline for a mammogram every two years is based on cost.  The truth is that some tumors are aggressive.  They can grow twice as much in two years.   A little war story here - a young-ish woman has a spot and her doctor said let's look at it again in six months.  she had metastatic breast cancer.

A lot of the "cost effectiveness" decisions are based on survival rates.  Not on preventing intensive treatments like adjuvant hormone therapy, radiation or even chemotherapy.

Prevention means catching a lesion early - one in eight women will get some type of breast cancer.  Rather than studying cost effectiveness, research should be looking at improving risk assessments and improving outcomes with less invasive treatments that punish the body.