Screening Tests

May 20, 2015

What, where, when and how often???

There have been numerous articles published in the last several months about over-screening and overuse of tests in the medical profession. Atul Gawande wrote a piece in the “New Yorker” entitled “Overkill” about the overuse of testing.

http://www.newyorker.com/magazine/2015/05/11/overkill-atul-gawande

He is an extremely qualified author on the subject. He is a surgeon, has a MPH, and researches public health. He states, “Millions of Americans get tests, drugs and operations that won’t make them better, may cause harm and cost billions.” His points are well taken and medically accurate. Having said that, which of my patients shall I suggest forego tests for an early breast cancer, lung cancer or thyroid cancer? Which patient shall I convince that finding the cancer early is not going to save his or her life?

You see, practicing medicine is an art as well as a science. We take an oath “to do no harm” but is diagnosing an early cancer doing harm?

The American College of Physicians ( ACP) recently revised their guidelines for 5 major cancers: breast, colorectal, ovarian, prostate, and cervical.

httphtm s://www.acponline.org/newsroom/hvc_cancer.

Once again, the guidelines are of a general nature and not specific for each patient, their family history and their co-morbidities.

Each patient is an individual and thus should be treated as such.

What should patients know?

They should know to talk to their doctor, explain their fears and anxieties. The doctor-patient relationship is sacred and each doctor can best evaluate the root of the anxiety, be it real or not.

For example, did your mother have breast cancer?

Are you BRCA positive?

Did either of your parents have colon cancer? Polyps?

Know your family history and know your own body to evaluate any changes.

Medicine is constantly evolving – I like to believe for the better. However, sometimes it is all about the almighty dollar. The bottom line must be that your health and well-being should be placed first in your eyes and in the eyes of your doctor.