By Barbara Bronson Gray, RN, MN
It can feel like a fast-paced game of ping-pong. Back and forth they go, experts chiming in on the latest research about screening tests that many of us were just getting used to. Prostate exams cause more harm than good? Mammograms are better less often? Colonoscopies not the only form of screening for colon cancer that’s effective? Yes? No? Yes?
The contradictions make some people worry that it’s all part of a national effort to clamp down on rapidly rising health care costs. Others fear the science is blatantly flawed. And for many, all they want is clear, unambiguous direction.
There are actually a few things going on simultaneously. The first is that we’re coming to terms with the limits of what we’ve called prevention. For the last 20 years or so, we’ve been led to think that just about everything can be nipped in the bud. Just catch it early enough, and we’ll be fine. For some diseases and conditions it still makes sense. But for others, not so much.
The first decade of the 21st century has been a time when we’ve been forced to face some of the limits of the new age of medicine. Many of our tests don’t improve the length or quality of our lives. Some can actual detract from that, causing side effects, anxiety and needless, sometimes high-risk procedures.
Too, we don’t interpret statistics all that well. It’s hard to hear the risks and apply them logically to our own lives. What does a 5% chance of getting cancer mean to you? For most of us, we’d like that number to be even lower, something like zero.
But we face other risks every day and ignore them. For example, there are about 40,000 car crash deaths every year. If you’ve been driving or driven in a car for about 50 years, your chance of dying in a car accident is roughly 1 out of 100. The risk of dying from accidental injury is one out of 36. The risk of dying from a fall is 1 in 246. Even with those odds, we’re comfortable on the freeway, climbing a ladder, hiking and horseback riding.
The problem with screening tests is that many of them don’t discriminate enough between a problem that will go away on its own, an issue that won’t go away but won’t hurt you, and a disease that could kill you. To that, some people say, “I don’t want to die, so test me and remove the problem.” We tend to be uncomfortable with ambiguity. We want things fixed.
Trouble is, treating some of the problems that are detected carry their own risks, and can cause a cascade of issues stemming from the medical intervention itself. Infection, loss of function – even death – can occur as a result of surgery or other treatment.
Recently the Susan G. Komen for the Cure’s mammography campaign was under fire for using misleading statistics to get women to have more mammograms. Critics argued that they were exaggerating the benefits and ignoring the harms.
Mammograms are increasingly picking up a microscopic abnormality called ductal carcinoma in situ, or DCIS. It’s currently treated with surgery, radiation and chemotherapy, but some physicians believe it’s unnecessary. Others disagree. Medicine isn’t sure.
Colonoscopies are expensive and require a day of “preparation,” eliminating stool from the bowel so it will be clear for inspection, and going for a procedure that often involves anesthesia. There’s a simple and cheap alternative, called fecal occult blood testing that just involves smearing some stool from the toilet paper onto a small card once a day for three days. The science suggests the results are good from both approaches. But we tend to opt for the more high-technology colonoscopy these days.
What can you do?
Develop a healthy skepticism to what’s promised by medicine. When you’re facing an option to get a screening test, ask about all the alternatives and what the specific pros and cons might be. Seek the basic statistics related to the screening test so you know just what you’ll be gaining by the test or exam. Explore whether the interval being suggested between tests is more frequent than necessary for someone your age.
Take action where you can. Losing extra pounds and getting more exercise may do more to cut your risk of heart disease and cancer than you realize. Wear seat belts. Get the vaccinations your physician recommends for you. Eat right and get plenty of sleep. And use screening tests as what they really are: another potential tool among many to help you hold on to your health.
To learn more, read these books:
“Overdiagnosed: Making People Sick in the Pursuit of Health,” by H. Gilbert Welch, M.D., M.P.H.
“The Decision Tree: Taking Control of Your Health in the New Era of Personalized Medicine,” by Thomas Goetz
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