“Screening, in medicine, is a strategy used in a population to detect a disease in individuals without signs or symptoms of that disease. Unlike most medicine, in screening, tests are performed on those without any clinical indication of disease.”

Screening is one of the methods used in preventive medicine to detect and hit a particular cancer or disease at its budding stages. It is a powerful strategy to reduce mortality from cancers and it has been proven to be an useful tool again and again to detect cancers at a very early stage. But the immediate question arises- How early is early?

A recent report suggests a significant increase in the number of these screening tests. It states that too many cancer screenings, too many heart tests and too many cesarean sections are being performed even though unnecessary- too many Americans are being over treated.

The present day American society relate tests to good health care and prevention. Prevention is all that your mother told you- eat right, exercise well, get enough sleep and don’t smoke- but people have slowly equated prevention to administering new screening tests. So who is to blame for an increasing number of unnecessary screening tests? Is it the doctors who stretch their preventive medicine prowess or the patients who have become so accustomed to a culture of medical awareness that they insist on extensive screening tests and treatments?

May be, it is a combination of both. The ever changing guidelines from National Institutes seem smudged and as tens and thousands of people are routinely screened for cancers and other diseases, the financial costs to the society is huge other than considering the harmful effects of some of these tests.

We have to remember- More care is not necessarily better care! Recently, a New England Journal of Medicine Study suggested that too many patients are getting angiograms (an invasive imaging test for heart disease) when they really don’t need them; and often too many times, doctors are opting for a repeat cesarean delivery in pregnant women after a first C-section.

Just last week, the American Cancer Society put more doubt into the guidelines suggesting routine PSA testing for prostate cancer. A few months ago, there were groups recommending against regular mammograms for women in their 40s as well as fewer pap tests for screening for cervical cancer.
The debate is paramount- even among experts, as to how much routine screening is actually beneficial and saves lives?

Sometimes, these screening procedures can detect very slow growing tumors- too slow to cause any harm- resulting in their treatment and thus causing harmful side effects and other medical complications from drugs. For Instance, the treatment of a prostate cancer which may be too slow-growing to be life threatening can mean incontinence and impotence! Other than causing such deadly complications, at times, screening procedures tend to give false positive results which ultimately lead to more invasive procedures involving much higher risks.

On the other side of the table, health professionals and advocacy groups argue about the improvement of survival chances and claim that saving even a few lives is worth the cost of routinely testing tens of thousands of people.

But some expert doctors believe this is bad science or think that this is a path of least resistance often taken by health professionals to protect themselves from lawsuits- a way of defensive medicine! Health professionals like Dr.Gilbert Welch, an Internist and a health outcome researcher from Dartmouth University say that doctors often order the test or a procedure as the fee-for-service compensates them for it. Likewise, he also points out the fact that the easily available medical information in media and on the internet has led patients to demand for routine tests- even though it is not necessary.

So what is the solution to this? What should you do as a patient? Is there any definite answer for this? Unfortunately, there are just guidelines and no single answer to any of these lingering questions. But, it all funnels down to the most important aspect of health care- the communication between the doctor and the patient.

Sit down with your doctor and talk extensively about your individual disease risk, not just the population risk. Discuss the pros and cons of testing and the possible harms of the test itself. Research the test before hand, research your family history and present it to your doctor. Not all cancers are the same and not every cancer presents in the same way in every person. Take help of the recommended online resources out there including the National Institute of Health and the American Cancer Society for information about screening procedures.

Doing all this can not only save you from unnecessarily complications, but keep you at bay from spending your hard-earned resources and time. And always remember the simple rules of prevention- eat right, sleep right, exercise right and don’t smoke.

For more information about screening procedures- visit these sites

American Cancer Society-http://www.cancer.org/docroot/home/index.asp

National Cancer Institute from National Institutes of Health-http://www.cancer.gov/cancertopics/screening

Tagged as: Cancer Screening