Do healthy adults need screening
Routine screening is now part of what we take to be responsible, preventative medicine. Most people assume that there are significant benefits to be gained from such procedures. Surely, if potentially fatal diseases can be detected at an early stage and cured, then we should be screened more often.
But does screening actually work? David Bender, writing in HealthWatch, warns us that the evidence is less good than we might imagine.
"Extensive check ups costing several hundreds of pounds each, though popular with many executives, (especially if their employers pick up the bill) show little if any, benefit apart from the detection of high blood pressure."
Bender also notes that even in the case of breast cancer, screening is of little benefit to women under the age of 50. Other forms of cancer screening, including bowel and prostate, are similarly disappointing in terms of the number of lives that they save. Even so, we might argue, screening can't do any harm. Well, sadly it can. Bender focuses on the anxieties generated by screening:
"Many of those given a complete medical check up will now be labelled as unhealthy in some way. If no cure is available may this not sometimes adversely affect the peace of mind and quality of life of people who had previously thought of themselves as healthy? As for cancer, if the result of a smear or mammogram is doubtful (as is quite common) intense anxiety may be caused. Further tests will need to be done and distressing doubt may continue for weeks or even months."
In extreme cases, the anxieties generated by possibly false positive tests in screening can be fatal. As reported in the Daily Telegraph , doctors have identified two women in the UK who committed suicide after receiving a breast cancer screening 'recall' letter.
A new survey in Sweden, reported in The British Medical Journal, indicates that breast screening in that country led to 100,000 women being wrongly informed that they had breast cancer. Of these, 16,000 had undergone biopsy and 400 had been subjexted to surgical operations, including mastectomy. The leading researcher in this study, Dr Goran Sjïnell, commented:
"Women should be warned about the potentially negative consequences of screening"
Neither Bender nor Sjïnell is arguing that we should abandon all forms of health screening. They do, however, warn against the exaggerated claims of some screening proponents and urge that people should not be coerced into check ups just to satisfy GP's quotas or some other popular 'campaign'.
By the way, next time you see your doctor, ask when he or she had a full medical check up. That might give you an indication of how much confidence the medics themselves have in screening procedures.