Sensible advice from a physician on how often you should screen for diseases
For years, the public was sold a bill of goods for constant early intervention. This past May, the data showed that most of these screens many people believed were life saving were in many cases worthless and the constant fear inducement of our own mortality made us demand these services, even though they in many cases did not save lives and led to interventions that were often more harmful than the what if disease scenario.
Many who hold these tests and screens sacred due to years of practice will have a tough time letting go, however, the data is the data. Some will say that patients are individuals and that it is different for them, however, sometimes now knowing is better, especially since we all succumb to something and in many scenarios, a problem will always be found in an older individual however, it does not always need to be treated.
A doctor offered some sound advice in a blog post I found. I thought you should read it and share it with your friends and family because it offers sound advice. Read it below.
How often should I screen for disease?
Surprise! It turns out that if every woman in the US got a mammogram every year, almost exactly the same number of them would still die of breast cancer. Why? Watch this video. Read this by TBTAM. Bottom line: mammograms don’t find aggressive cancers soon enough (by definition, you can’t), while too many of the cancers they do find were never going to be fatal anyway. This is what “over-diagnosis” means.
The same problem arises when discussing other kinds of cancer screenings. Prostate cancer, for example, also tends to age more slowly than the men it’s growing in, usually outliving them (patients die of something else first). Thus, the official acknowledgment that the harms of screening outweigh the benefits has resulted in the changed official recommendation from “screen” to “don’t screen.” Then again, I did just pick up a case of completely asymptomatic metastatic prostate cancer from a screening PSA in a 50-something year old patient. Go figure.
Even the venerable annual physical isn’t worth it. No one can show any actual health benefit to any kind of annual medical review (in the absence of symptoms, of course). It has been shown that patients who have a regular relationship with a primary care physician tend to do better than folks who never see a doctor. But in the absence of acute illness, how does one go about establishing that relationship? Some kind of periodic evaluation is obviously in order, but what “period” should we recommend (given that “annual” seems to be too frequent)?
The United States Preventive Services Task Force is one body charged with generating these kinds of official recommendations. This doesn’t stop all kinds of other folks (medical specialty societies, disease oriented groups, and so on) from also promulgating their own guidelines. Is it any surprise when these conflict? (hint: no)
The thing about guidelines is that, again by definition, they represent population-based recommendations. They are derived from population-based data (studies done on large numbers of people), which result in statements that are intended to apply to populations, or, well, large numbers of people.