Screening Sense

Everybody wants to stay healthy and live a long life, and prevention of disease is one way to help you meet that goal. But some disorders, like many cancers, can’t be prevented. The next best thing is to detect them in their earliest stages when they’re most amenable to treatment. Routine screening tests are recommended for some of the more common cancers like breast and prostate.

Until recently, the guidelines for screening set by the medical community in this country were designed with maximum detection in mind. The goal was to use the most sensitive testing available in order to find every possible case of early cancer. It is a noble objective, but not without flaws. Now, the medical community is revisiting this issue.

In the May 19 issue of Annals of Internal Medicine, a group from the American College of Physicians (ACP) suggests that many medical professionals and the public have overestimated the benefits of this “high-intensity” approach to cancer screening. Increasingly, however, they are becoming more aware of the other side of the coin. Intensive screening leads to greater harm to patients and increased medical costs.

This awareness has prompted a new way of looking at the screening issue that considers the tradeoffs between benefits, and harms and costs of various screening strategies in terms of value. The authors write:

High-value screening strategies provide a degree of benefit that clearly justifies the harms and costs; low-value strategies return disproportionately small health benefits for the harms and costs incurred. Value and intensity are not the same.

The point is that although a high-intensity screening approach may, indeed, have many benefits, when objectively measured, the benefits often do not outweigh the negatives of significant harm to patients and added cost. That makes it a low-value strategy. The ACP suggests that the American medical community consider more high-value strategies when setting screening schedules. These strategies often take an intermediate level of intensity that best balances benefits with harms and costs. That might mean reserving the most sensitive tests only for people with certain risk factors for that particular cancer.

The ACP offers advice for screening recommendations for five common cancers – breast, cervical, colorectal, ovarian and prostate – in average-risk adults. These are people who have no family history or other risk factors and who do not have any cancer symptoms. Before dispensing this advice, the ACP reviewed clinical guidelines and evidence from a number of sources including the US Preventive Services Task Force, The American Academy of Family Physicians, the American Cancer Society, the American Congress of Obstetrics and Gynecology, the American Gastrointestinal Association and the American Urological Association. Most of these organizations have already embraced high-value strategies, so the ACP’s advice for screening is not earth shattering.

Screenings remain an important part of your routine preventive health care, so continue to follow your doctor’s recommendations. He or she follows the guidelines approved by the American Cancer Society or other appropriate medical organization and will have access to the most up-to-date schedule for exams. If you have questions or concerns about the necessity of a screening, bring them up to your doctor. Be smart and be your own advocate!