In order to make medical screening worthwhile, it must first follow the law of Primum non nocere, which means “first, do no harm”,an edict doctors try to follow. In many cases, healthcare screening does pay off and does no harm to the individual having the screening test. Some, however, do not follow this rule.
Think about a test as simple as a PSA test for prostate cancer. It is a relatively safe blood test that may show if an individual has no inherent risks. But what about situations in which the screening test shows an elevated PSA but no real cancer exists. This puts a man who doesn’t have cancer through a painful and potentially dangerous prostate biopsy to look further for cancer.
On the other hand, a negative test or normal PSA does not mean a man does not have prostate cancer. This would be an individual that would have a cancer growing within them without benefit of medical expertise to get rid of the cancer.
Colon cancer screening is another screening test that may cause more harm than good. A stool occult blood test is simple and painless but has a high false positive rate. This means that more people get colonoscopies as follow up exams that do not really need them. Colonoscopy exams carry their own risk of problems. A small percentage of those who get a colonoscopy suffer from a perforated intestine. The risk is higher in the elderly who can ill afford to suffer from a perforated intestine. Such a complication can be dangerous and deadly.
Other screening tests are perfectly safe to take. A cholesterol level can screen for the chances of having heart disease and can result in taking cholesterol medication or changing the lifestyle of the individual with high cholesterol. There are basically no risks in screening for this disease with the small exception of some side effects from taking cholesterol medication. Otherwise, the screening test is extremely positive and can save lives.
Screening for diseases in people who have no symptoms is very different from looking for disease in those who have evidence of disease or a strong family history of the disease. It is a shift from the way physicians have traditionally practiced medicine. But is it better? In order for it to be better the test needs to be safe and have a low number of false negatives and false positives. It needs to lead to a diagnosis and not to other testing that is higher risk and perhaps dangerous.
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