Health Screening Contributes to Unnecessary Testing
People are often encouraged to undergo health screening by hospitals and for profit companies. The Chief Medical Officer of the American Cancer Society estimated that hospitals could make $5000 from each free prostate cancer screening due to subsequent biopsies & treatments.
An article in a recent issue of The Atlantic Monthly (October 24, 2012) included this example, “Important screening tests could save your life. All for $129! No Doctor’s Order Necessary!” Some companies ask questions such as, “If your church is endorsing a health screening fair, it must be good, right?”
These ads reinforce the traditional belief that it is always better to prevent or catch a disease early than to treat it later. However, more recent research has discovered that health screening often finds insignificant abnormalities, called incidentalomas, that subsequently lead to over-diagnosis, overtreatment and possibly harm. In spite of this new data, patients usually opt for health screening because they tend to overestimate the risk reduction associated with screening and underestimate risk of intervention (Ann Fam Med 2012; 10:495-502).
Screening really promotes disease, not health. Today, the fastest way to get heart disease, autism, glaucoma, diabetes, vascular problems, osteoporosis and cancer is to be screened for it.
The value of health screening is hotly debated by different medical specialties. For example, USPSTF has stated that no men should be screened for prostate cancer with PSA. The American Cancer Society & American Urological Association disagree with this broad statement.
Physicians often have difficulty interpreting data about screening tests. Some do not understand that survival statistics are susceptible to lead-time and over-diagnosis biases (Ann Intern Med 2012;156:340-9). Health screening clinical trials often publish disease specific & not all cause mortality. Physicians need to be able to explain the risks and benefits of screening tests to patients so they can make and informed choice before participating.
For more detailed information on the value of health screening, I highly recommend the book, Seeking Sickness:Medical Screening and the Misguided Hunt for Disease by Alan Cassels.
