Cancer Screenings: Sometimes More Harm Than Good

Many are under the impression that the more screening tests their doctor prescribes, the healthier they will be. Testing often is the key to staying in good health, right? Not necessarily.

The Choosing Wisely initiative, started by the American Board of Internal Medicine and now joined by over 60 medical societies, was started in order “to spark conversations between providers and patients to ensure the right care is delivered at the right time.” In this campaign, medical societies publish lists of things doctors and patients should not do. The lists are available at www.choosingwisely.org.

Controversy often surrounds discussed recommendations for screening for illnesses. Multiple medical societies have made recommendations about cancer screening that you do not need. The bottom line for all these is that there is not good evidence that some screenings make a difference in death rates and can even increase death rates by leading to unnecessary surgeries.

Some examples:

• Gastroenterologists recommend to not repeat a colorectal cancer screening (by any method) for 10 years after a high-quality colonoscopy is negative in average-risk individuals.
• Preventive medicine specialists recommend not screening for cervical cancer in low-risk women aged 65 years or older, or in women who have had a total hysterectomy for benign disease.
• Gynecologists recommend not screening for ovarian cancer in women with no symptoms and at average risk.
• Family physicians recommend not routinely screening for prostate cancer using a prostate-specific antigen (PSA) test or rectal exam. They also recommend not screening women older than 65 years of age for cervical cancer who have had adequate prior screening and are not otherwise at high risk for cervical cancer.

Two societies — SGIM and American Geriatrics Society — recommend basing cancer screening decisions on life expectancy. Their reasoning is this: A cancer screening test’s goal is to find a problem so early that it makes a difference in the person’s life. If the patient’s life expectancy is less than 7–10 years, finding a problem very early may lead to troublesome interventions when the underlying problem would not have caused a problem during that 7–10 years anyway.

One last thing: According to the American College of Preventive Medicine, patients who have shown no symptoms should avoid using whole-body scans for early tumor detection. Whole-body scanning with a variety of techniques (MRI, SPECT, PET, CT) is marketed by some to screen for a wide range of undiagnosed cancers. However, whole-body scanning has a risk of false positive findings that can result in unnecessary testing and procedures with additional risks; including considerable exposure to radiation with PET and CT, a very small increase in the possibility of developing cancer later in life, and accruing additional medical costs as a result of these procedures.

In short, make sure you and your doctor are not requesting more cancer screenings than necessary. Take the time to become information in order to choose wisely at www.choosingwisely.org. It could save you time, money, and unnecessary pain and suffering.

Sources: Ken Brummel-Smith, MD, and Choosing Wisely®