During my medical career I have heard the following statements:
Early detection offers the best chance of recovery.
If you’re waiting for symptoms, you’ve waited too long.
Knowledge is power, and the sooner you have it, the better.
Over time, I’ve found that they are often not true. Many health problems go away on their own. In such cases, testing early can lead to unnecessary effort, time, and medical costs. Some tests are invasive and carry a significant risk of complications. Minor abnormalities may lead to further testing. There is also a fear of waiting for results or finding out that you have an anomaly of uncertain importance that requires additional assessment.
Why wait? Why not test and treat right away?
Sometimes the “healing” takes the time. This is one of the reasons many doctors recommend vigilant waiting rather than aggressive testing. Knowledge is power only if you can do something useful with it. And many conditions aren’t worth knowing about or treating until they cause symptoms.
For these reasons, the American Board of Internal Medicine Foundation launched the “Choose Carefully” campaign in 2012. Their mission is to promote more selective, evidence-based testing and treatment, and to cut out unnecessary testing and care.
Six conditions for which early detection and treatment is not clearly helpful
- Certain leukemias and lymphomas. While malignant, some leukemia and lymphomas can progress so slowly that the risks of treatment outweigh the benefits. For example, therapy for early-stage chronic lymphocytic leukemia that does not cause symptoms cannot be recommended.
- Sarcoid. This condition, of unknown origin, often causes enlarged lymph nodes and inflammation in a wide variety of organs. However, if there are no symptoms, a normal physical exam, and normal results from routine tests, no treatment may be warranted.
- Some types of Prostate cancer. Close monitoring without treatment may be recommended in men with prostate cancer that has not spread outside the prostate and does not appear aggressive under the microscope. This finding has created uncertainty about whether to check for prostate cancer (for example, with a blood test called PSA).
- arthrosis. This is the most common arthritis, and it becomes almost universal as it ages. Treatment cannot be warranted for mild symptoms.
- Slightly high LDL cholesterol in people at low risk of cardiovascular disease. Healthy lifestyle recommendations, such as regular exercise, losing weight, and choosing a healthy diet, are routinely recommended for this group, but medication is not.
- The cold and many other viral infections. Our immune system is able to fight off most viral infections without drugs or other treatments. Treatment is usually limited to supportive measures (such as cold medicine, fluids, and fever reducers) and does not depend on test results.
When not to wait: Tests to rule out a serious diagnosis
When there is a significant suspicion of a serious medical condition that needs early detection and treatment would Make a difference, your doctor should make every effort to find out sooner rather than later.
For example, if a chest x-ray shows an abnormality suggestive of cancer, further evaluation should be done immediately. If no cancer is found, that’s great – but that doesn’t mean the tests were unnecessary. Rule quickly out A worrying diagnosis that seems somewhat likely is often why testing is recommended.
What about testing for peace of mind?
A person who is uncomfortable and doesn’t know why they may be worried, distressed, or even depressed. It’s easy to imagine the worst, even knowing it’s unlikely. Getting a diagnosis – or ruling out a diagnosis – can provide reassurance and relief that can be profoundly helpful.
Often, however, security can be guaranteed without extensive testing. For example, imaging tests like an MRI are not recommended if a person has recently developed back pain but no other symptoms or abnormalities appear during a physical exam because we know the chances of finding anything serious are quite small. Extensive, costly imaging is not required – and can unnecessarily increase anxiety if a random abnormality is discovered without consequence.
The comforting value of early detection has been used by those who benefit from it. Some imaging centers encourage scans, ultrasounds, and other tests without your doctor’s input. Terrifying ads describe horrific things could Go ahead in your body now: aneurysms are about to burst! Almost clogged arteries about to have a stroke! Enlargement of tumors just before they spread throughout the body! Of course, these tests may not be covered by your health insurance. As a result, these ads are asking you to spend thousands of dollars on “Peace of Mind”. It ignores evidence that such tests are generally not helpful and can cause harm.
Some organizations offer their executives medical tests that go beyond the usual medical care. It is seen as an executive benefit to having body scans looking for early disease treatment. Again, such testing has real drawbacks and, in my view, may not be a huge benefit at all.
Early detection and treatment can save lives – just not for every health problem
Sure there are many conditions where the earlier the diagnosis the better. That’s because we have effective treatments that work best in the early stages of the disease. For example, breast and colon cancer can be cured if caught early enough. This is why screening tests, including mammograms and colonoscopy, are so important: they can spot an early tumor before it reaches an untreatable, ultimately fatal stage.
There are also non-cancerous conditions where early diagnosis and treatment will improve outcomes: rheumatoid arthritis, appendicitis, and bacterial pneumonia are good examples.
The final result
The importance of early diagnosis and treatment is clear for certain diseases. But for others, it’s oversold. It could happen that our ability to test has exceeded our ability to interpret the results. Just because we can Testing for hundreds of diseases doesn’t mean we should.
The culture of American medicine has long been “more care – and more testing – is better care”. However, as we continue to spend more on health care without improving health accordingly, this assumption is worth reconsidering. If you feel unwell or have health concerns, talk to your doctor about how to proceed. But don’t be surprised if he or she doesn’t recommend a specific treatment or exam. A plan that lets time pass with close follow-up can save you the cost, fear, and risk of unnecessary care.
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