Friday, July 17, 2009

Cancer screening

One of the most interesting classes I took in grad school examined the cost effectiveness of various public health interventions. We discussed prostrate cancer screening, cholesterol screening, and cervical cancer screening. It was fascinating to learn that many public health prevention interventions make sense but are not always cost effective. That's another story.

Today, the issue is cancer screening. According to this article in the NY Times, screening the entire population for certain types of cancer is not cost effective and can even be harmful. Certainly cancer screening generally is positive - and screening for some types of cancer is very useful. Don't get me wrong, I'm not down on screening generally. But blanket screening is not helpful and "do come with medical risks" as well as economic costs.

This article states that there are several possible bad outcomes, including "needless anxiety," "unnecessary procedures that can lead to complications," and false positives, to name a few. "Screening is useful only if, on balance, the deaths prevented by treating cancers outweigh the harm done by treatments that are not medically necessary."

For example, the federal recommendations for cancer tests include cervical cancer screening - but the catch is that the recommendation is to screen every 3 years. Many women are told to come in annually. Part of this is to get women in the door to make sure they are healthy overall, but part of this is needless screening. Women who have had 3 normal Pap smears in a row can receive cervical cancer screening every 3 years, not every year.

The bottom line: Talk to your physician about which screenings are appropriate for your age, lifestyle, risk factors, and family history. You may need some, but you may not need all.

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