I'd like to relate my wife's experience with the screening trap. I apologize for the long rant.

About 20 years ago, our local hospital sponsored a Women's Heart Health event. There were some presentations about diet, exercise, etc, but the main draw was a calcium screening. I think she paid $100 for the whole thing.

Cardiac score was normal so all is well, right? Well, not quite. The radiologist noticed something a little unusual in her lung. Her mom was a smoker, so you can't rule out lung cancer from second hand smoke. Probably nothing, but better to be sure, right?

Next step was a contrast CT. The radiologist quickly determined that the unusual spot was just a little vascular anomaly of no consequence. All is well, right? Not quite. In reading the CT, he noticed a nodule in her thyroid. Better get that checked out.

She went for yearly ultrasounds of her thyroid for the next ten years or so. The nodule was mostly stable, but finally crossed the magic line (I think it was 5mm) where a biopsy was recommended.

Needle biopsy showed some abnormal cells indicative of thyroid "cancer". I deliberately put that in quotes, because there is some argument that it shouldn't even be classified as cancer. It is almost NEVER fatal. Even if it spreads, radioactive iodine can target the cancer cells with near 100% success.

Of course, no one wants to walk around with "cancer" so her doctor recommended the affected half of the thyroid be removed. She underwent the surgery and recovered in a week. As a side note, the lesion that the surgeon removed was actually smaller than it appeared on ultrasound, so the trigger for surgery was not really met.

Great, the cancer is gone. Well, just a few years of follow up ultrasounds to check the other side and take some supplemental thyroid hormone. Her surgeon cut her loose after about 3 years.

But wait! Her endocrinologist(for the thyroid hormone) insists she continue to get yearly ultrasounds "just to be sure".

We are now 20+ years past the initial cardiac screening, she is still going for yearly ultrasounds and is committed to taking thyroid hormones for the rest of her life.

I know this is an anecdote, but I am fairly certain that it happens frequently. I think it was Vinny Prassad that said: "Our medical system is very good at making lifelong patients out of people who just want to be left alone"

Be careful when you agree to "harmless" screenings.

I can agree with much of what was said in the article based upon my recent experiences.

Much of the testing is undertaken for liability purposes, but much results from a "cascade" of information resulting from prior testing.

My cardiologist asked me to get a calcium scoring CT. Then he proceeded to tell me about two outcomes in his practise both of which presented opposite outcomes compared to the calcium scores.

I looked at him and asked him why I shouldn't just step outside and burn a $100 bill based upon the validity of calcium scoring CT scans? He's a good guy and took it well.

RMD

quote:

Originally posted by MNSIG:
^^^^^^

Yes. Cancer screening in asymptomatic patients is another one. Mandrola does periodic You Tube discussions with an oncologist/epidemiologist Dr Vinay Prassad.

I actually kind of agree with a lot of the proactive cancer screening that's starting to come out. Having lost multiple family members to it and being in a very cancer heavy career.

On the testing issue, I was in the doctor’s office for something else that required a blood test and the PA asked if I wanted a PSA test as well. I said sure, why not? and it lead down a rabbit hole of exams, blood tests, digital exams and finally an MRI, all to find nothing, other than I had a chronically high end of normal PSA.

Talking to the urologist one appointment, he told me that I was going to hate the PSA test, because it had a 20% false positive and 2% false negative rate. Oh and about 20% of all men will eventually get prostate cancer. When I asked why they use such a lousy test, he told me the alternative was to put every man over the age of 50 in an MRI.

I am now very hesitant about tests that I don’t want or ask for.

quote:

Originally posted by Nuclear:
Oh and about 20% of all men will eventually get prostate cancer.

Close to 100% of all men will eventually get prostate CA...if you live long enough. Just about everyone dies with it, not many die from it.

quote:

Just about everyone dies with it, not many die from it

True but it’s still the #2 cause of cancer deaths in men.

What would likely be considered an unnecessary stress test saved my life. I was 33 years old and a former varsity rower in college. My only symptom was a twinge in my chest when I got really stressed at work.

My doc ordered the stress test just to be safe but didn’t think it was likely to show an issue. Well the test showed my ejection fraction was 15% (normal is 75% and 10% is when you start looking at a transplant). That low of an EF also puts you at risk of ventricular tachycardia and sudden cardiac death.

Well I am now about to turn 56 and have had bouts of VT that almost killed me on multiple occasions (first one had 54 shocks from the ICD before they turned it off). If I hadn’t been diagnosed and gotten an ICD I would not have survived.

We bitch about “unnecessary” testing but it does catch unlikely diagnosis and save lives.

about 45 years ago I went to work for a local hospital in their warehouse... flunky job... do get perminant employment had to have a blood test a basic physical.... blood test came back I had a sever liver enzyme deficiency ... nurse and doctors suggest I drank too much.. I laughed at this... one or two beers on the weekend was my max. Then I remembered working in a cloth laminating plant for a summer breathing solvents for 8 hours and got worried.... got an appointment with a specialist and he determined the next step would be a biopsy but first let's run another blood test... few weeks later (making plans to get cut on) the doctors office calls and says, "oh by the way we got your 2nd blood test back and you are fine the first one was a mistake."