Too Much: Testing?

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Too Much: Testing?
 

– Reported, July 4, 2012

 

BOSTON, MA ( Ivanhoe Newswire) — High blood pressure, diabetes and cancer. We’re taught to catch diseases early you need to get screened and get tested, but is it always the right thing to do? Could we be doing more harm than good?

“No family history, no symptoms,” Michelle Stapleton, a breast cancer survivor, told Ivanhoe.

But when Michele went in for a mammogram at 41, they found nothing but a suspicious spot. Turns out it was cancer. Michele opted to have both breasts removed to avoid chemo and keep the cancer from coming back, but a later test predicting recurrence still put the mother of two in the gray zone, so she opted for 12 weeks of chemo anyway, raising her chance of survival from 85 to 91 percent.

“It seems small to me for what you have to go through at one time but that’s 6% more of a chance that i won’t have it, so anything more that I can do to insure that I’m going to be here for my children is worth it,” Michele said.

It was worth it for her but maybe not you. Dartmouth’s doctor Gilbert Welch says we all have abnormalities in our bodies but most are harmless.

“We don’t know which abnormalities will matter but we tend to treat them all and thereby some people are being treated for things that will never bother them and yet they can be harmed by treatment,” Dr. H. Gilbert Welch for the Dartmouth Institute for Health Policy and Clinical practice and author of Overdiagnosed, explained.

A recent study out of Norway estimates between 15 and 25 percent of breast cancers found by mammograms would not have caused any problems during a woman’s lifetime, but were treated anyway. The study found for every 25 hundred women screened, one death would be prevented but six to ten women will be overdiagnosed and treated. Doctor Welch says this is especially true of women in their forties.

“Maybe not starting mammograms at age 40 and starting them at age 50 and maybe not doing them every year but doing them every other year might actually be in their interest,” Dr. Welch said.

He also believes there’s too much testing for prostate cancer.

“Twenty years ago a simple blood test was introduced called the prostate specific antigen and twenty years later about a million men have been diagnosed with a cancer that was never going to bother them,” Dr. Welch said.

That’s prompted the U.S. preventive services task force to advise against the test in healthy men.

“I think our focus in medicine has been traditionally in the 1 out of 1000 we can help, and I think the question the patient needs to ask is what happens to the other 999?” Dr. Welch said.

Then there are conditions defined by numbers like high blood pressure, diabetes and osteoporosis. Over the last twenty years, those numbers have expanded labeling more Americans as abnormal and in need of treatment.

“All of these things have a way of finding people who otherwise might never come to our attention and might live a normal life,” Dr. Welch said.

Ultimately, doctor Welch says it comes down to finding the right balance.

“I’m not saying that people either should or shouldn’t be screened, I think we should tell the truth. We need to tell them about both sides of the story,” Dr. Welch said.

Allowing patients like Michelle to make better decisions.

“i have young girls,” Michelle said. “I’ve got to be here.”

In a recent medical survey, 42 percent of primary care physicians thought their patients were overtreated. The reasons include malpractice concerns and not enough one-on-one time with patients. 28-percent of the doctors in the survey admitted to practicing too aggressively.