Most doctors recommend regular checkups for their patients. A physical is designed to screen for the issues that most commonly threaten our health; often this involves doing lab tests, x-rays, and, at certain times in life, procedures such as mammograms, colonoscopies, and tests for heart disease. Sometimes these tests result in what are referred to as “false positives” and “false negatives.”
Despite all of our technological advances, screening techniques are not perfect and, in a small percentage of cases, yield information that may be inaccurate. Doctors call these results false positives or negatives because they can completely miss diseases in some cases (a false negative) or provide suspicious information that can cause concern when nothing is actually wrong (a false positive). Besides the fear of being diagnosed with a possible dreadful disease, a false positive usually means more tests and follow-up doctor visits. The process can be stressful and upsetting to the patient as well as costly.
For example, a mammogram can indicate breast cancer when no cancer exists. I have had patients with false positive findings on mammograms who had to undergo a biopsy only to find out they were healthy. In fact, the U.S. Preventive Services Task Force recently released new guidelines pushing the start date back for mammograms from age 40 to age 50, citing the undue stress caused by false positives. On NPR’s All Things Considered, one doctor stated his support for later mammograms precisely because of the false positives issue.
That argument seems rather backwards to me. The challenges that come with testing for breast cancer and other diseases are not good reasons to delay or give up screening. Other patients of mine who underwent mammography were found to have breast cancer, and because of that early detection, they now have an excellent prognosis.
The anxiety and costs of false findings pale in comparison to the physical suffering, expense, and emotional turmoil experienced when we or one of our loved ones are diagnosed with something that was missed in an earlier screening. Never is anyone in this situation without regret.
I see many patients who go to the doctor only when they get sick. Recently, a 32-year-old man came in after seeing an optometrist, who noticed changes in the his eyes and referred him to me for screening for diabetes. The patient did not have a regular doctor and visited emergency clinics for colds and minor illnesses. He told me he was afraid to have a physical because he did not want to find anything wrong. His examination and laboratory testing indicated he has advanced complications from diabetes, including kidney and eye disease and problems with blood supply to his feet. This is the classic example of someone whose illness could have been intercepted earlier with simple screening techniques. Imagine how different his life would be if he had come in regularly to keep from getting sick in the first place. ortunately, he is now bringing his children in for screening and education.
By far, the cheapest form of health care is prevention. Early treatment of diabetes, hypertension, high cholesterol, and cancer would drastically change outcomes. That, in turn, would prevent complications and save our economy millions of dollars in hospitalization and in lost productivity. But first, these diseases must be detected. The only way to discover them early enough to make a difference is by screening, and I believe in doing that as early in life as is feasible.
Undoubtedly, prevention should start with campaigns to treat or prevent smoking, obesity, and stress. But targeting only those issues too often gives people a false security about their own health –– they often assume that are healthy when in fact they may very well not be. That’s why I make a practice of verifying my patients’ actual health status.
The good news is that information from diagnostic screening is reliable in the vast majority of cases, and researchers are constantly striving to find better screening techniques that yield more accurate information at lower costs.
“Early” has always been our best position, especially with diseases like cancer. But how can we have “early” if we screen late or not at all?
I appreciate your viewpoint. False positives are tricky issues, but preventive medicine is the only way to go. I do have a question which you didn’t address. What about the risks of radiation from regular mammograms? Is it too low to outweigh the positive benefits?
Good question, and I hope the Doc answers it. I noticed Barbara Ehrenreich weighed in on this the other day — specifically mentioning the increased danger from radiation, and she’s a cancer survivor.
Patty, thank you for your comments. Regarding the question of radiation risk from mammography and other diagnostic test, it is the prevailing belief that benefits greatly outweigh the risks. Obviously, we must consider radiation exposure in determining at what age to begin screening because the earlier exposure begins, the higher the risk of potential complications. This will remain an issue until we perfect MRI and sonographic techniques. These are non-radiative and in time will become less costly. In the near future I will write a piece to further address this issue. Below are 2 links which will provide further information.
http://www.acr.org/HomePageCategories/News/HealthcareNews/MammogramRadiation.aspx
http://www.cancer.org/docroot/CRI/content/CRI_2_6X_Mammography_and_Other_Breast_Imaging_Procedures_5.asp