Lies and damn lies abut health screening

[Rich_by_the_Bay]

Every so often a thread will appear on the board about the risks and benefits of various health screening tests. More testing is not necessarily better and in fact may be harmful.

Here's a good article addressing some examples.

 

[rodi]

Interesting article. I was surprised at the recommendation to not do Pap tests between age 21 and 30... nor test for HPV. Maybe it's because I tested positive for HPV at age 28 (and underwent the cryo procedure to take care of it.) I assume if there are symptom it would be recommended to test/treat? Since HPV is generally a sexually transmitted disease - that can lead to cervical cancer... I would assume you'd want to test/treat during the sexually active years of the 20's. (I was, of course, a virgin till I was married at age 38, LOL.) I have several friends who also tested positive for HPV in their 20's. So that recommendation.

I understand the reasoning behind the CA-125 test. It's an indicator, but not a conclusive test. My mom's CA-125 levels remained in the low end of the normal range even with stage 3 ovarian cancer. It never got into the "elevated" range till after it was metastasized after the first round of chemo/surgery failed. My primary did order a CA-125 test on me just as a baseline... so if I show any symptoms they can see if it's elevated relative to that baseline. Same with a baseline U/S of the reproductive area - just to have a baseline to refer to if I showed any symptoms going forward. But that was over 10 years ago with no repeats... That struck me as a good balance given the family history.

I understand this is all based on statistics... by my cousin flunked his PSA test and had prostate cancer (not a false positive on the test)... he was 42 at the time. One case does not make a statistical pattern... but I'm glad he got the test when he did.

Edited to add: My family is a non-typical family. Kind of a cancer cluster unto itself. Mom - Ovarian cancer. Dad prostate cancer (cured) then Multiple Myeloma. Brother Melanoma (cured) then a very aggressive neuroendocrine carcinoma. 3 of 4 grandparents had cancer. 2 of 3 cousins have had cancer - the one who beat prostate cancer is now 2 years cancer free after testicular cancer.... Like I said - we're not typical.

 

[easysurfer]

I know for the PSA, when I was in my early 40's my doctor was talking about at 50 to get that and the colonoscopy test done. But when I hit 50, my doc did kinda say, the PSA test isn't that conclusive, and he just does the regular of fashioned way of checking at my annual physical.

 

[razztazz]

I know for the PSA, when I was in my early 40's my doctor was talking about at 50 to get that and the colonoscopy test done. But when I hit 50, my doc did kinda say, the PSA test isn't that conclusive, and he just does the regular of fashioned way of checking at my annual physical.

Actually the PSA is very conclusive. It measures PSA very accurately. It doesn't and never was able to "detect" cancer. In fact one of the bogus statements in that article referred to the "harms caused by a PSA test" . PSA test causes no harm. Thinking you need a biopsy because of a result, now there's the harm.

I've been dealing with the PSA almost since the day it was invented due to prostatitis I had beaucoup years ago. My urologist says I know more about it that he does. The doctor who invented the test stopped recommending it --as a screening test-- years ago but it still has uses. Corroborating a digital exam is the best use of it. But it never detects cancer. It only detects PSA.

 

[ArkTinkerer]

Have a friend who was hounded by a doctor to have prostate surgery based on not much more than the PSA test and family history. Even sent him notice by certified mail to come in for surgery or he would not be responsible for the lack of care. Went for a second opinion with a doctor who had helped his father. That doctor put him thru the wringer and said there was no issue. Said it was more than a difference of opinion--that the main concern was the year and model of car the first doctor was driving. One of the harshest things I've heard one doctor say about another's diagnosis to a patient.

 

[donheff]

Actually the PSA is very conclusive. It measures PSA very accurately. It doesn't and never was able to "detect" cancer. In fact one of the bogus statements in that article referred to the "harms caused by a PSA test" . PSA test causes no harm. Thinking you need a biopsy because of a result, now there's the harm.

You state this in a manner that sounds like it is debunking the whole article - "one of the bogus statements." Since many if not most biopsy decisions are made based on high PSA scores (and their emotional impact on patients) it is fair to question taking the test. To talk about the "limited potential benefits and substantial harms" seems to address the ultimate purpose of the test (decision making based on numbers) rather than the accuracy of the numbers.

 

[rodi]

You state this in a manner that sounds like it is debunking the whole article - "one of the bogus statements." Since many if not most biopsy decisions are made based on high PSA scores (and their emotional impact on patients) it is fair to question taking the test. To talk about the "limited potential benefits and substantial harms" seems to address the ultimate purpose of the test (decision making based on numbers) rather than the accuracy of the numbers.

I think his point was that the PSA test, by itself, is fairly non-invasive. It's what you do with the results that bear the risk... NOT THE TEST.

Same is true for the CA-125. It's a blood test. So very little risk from the test itself... But the results do not diagnose cancer... there is no definitive test for ovarian cancer....

And mammogram as well - it's uncomfortable and potentially painful (pancaking your ta-tas is not the most pleasant experience and some techs are VERY aggressive about squishing the plates as tight as they can.) But it's non-invasive... no skin is broken, etc... but some women have dense breast tissue and that might lead a doctor to want to biopsy "just in case".


These tests are not the risk. It's what is done with the data that is the risk.

I understand completely the reasons for reducing the frequency of these tests and increasing the age that they start. Statistically that makes total sense. Hopefully family history and symptoms would trump these guidelines however.

 

[donheff]

I think his point was that the PSA test, by itself, is fairly non-invasive. It's what you do with the results that bear the risk... NOT THE TEST.


These tests are not the risk. It's what is done with the data that is the risk.

I am not sure what the distinction is. All tests produce data that we use. If the use of the data is causes problems why take the tests? The ONLY reason I can see for taking such tests is if there are good uses of the data. Are there good uses of PSA test data? Or are the prescribed uses always those that lead to more negative than positive outcomes?

 

[ArkTinkerer]

I am not sure what the distinction is. All tests produce data that we use. If the use of the data is causes problems why take the tests? The ONLY reason I can see for taking such tests is if there are good uses of the data. Are there good uses of PSA test data? Or are the prescribed uses always those that lead to more negative than positive outcomes?

Boss in engineering use to pound into us that before you do a test, know what you expect the results to be, and also know what you are going to do depending on the results of the tests. If you can't do those two things, don't bother with the test.

 

[Meadbh]

Boss in engineering use to pound into us that before you do a test, know what you expect the results to be, and also know what you are going to do depending on the results of the tests. If you can't do those two things, don't bother with the test.

That's what I learnt in medical school too (not in the U.S.). The fact is, if you do the test, it influences future decisions, intentionally or not.

 

[Midpack]

Actually the PSA is very conclusive. It measures PSA very accurately. It doesn't and never was able to "detect" cancer. In fact one of the bogus statements in that article referred to the "harms caused by a PSA test" . PSA test causes no harm. Thinking you need a biopsy because of a result, now there's the harm.

I've been dealing with the PSA almost since the day it was invented due to prostatitis I had beaucoup years ago. My urologist says I know more about it that he does. The doctor who invented the test stopped recommending it --as a screening test-- years ago but it still has uses. Corroborating a digital exam is the best use of it. But it never detects cancer. It only detects PSA.

Mostly semantics. Ironic in that a DRE immediately preceding a blood draw for PSA testing has been shown to be one of several CAUSES of falsely elevated PSA results. The test may be accurate on a stand along basis, but that ignores the bigger picture, and all the resulting misuses of PSA testing.

Most patients, many GP's and at least some urologists don't seem to know how to use or interpret PSA results IME. Been there, done that - with my GP, nurse and urologist fighting me the whole way, insisting my elevated PSA indicated they needed to perform a biopsy...a simple $50 retest showed they were all wrong. If I hadn't done my own research, I'd have gone through it all unnecessarily.

Reasons for a Falsely Elevated PSA include:
-recent sexual activity or ejaculation
-recent digital rectal exam
-recent prostatitis (infection or inflammation of the prostate)
-recent urinary tract infection (UTI)
-recent placement of a catheter into the bladder (sometimes used to drain urine from the bladder in men who have severe difficulties urinating)
-recent cystoscopy (a thin instrument with a camera that is inserted into the bladder)
-vigorous or extended bicycle riding
In order to avoid a falsely elevated PSA level, all of the above activities should be avoided (if possible, of course) for a few days prior to the PSA test. You should alert your physician if any of these have occurred in the days leading up to your PSA test. Typically, a PSA test can be easily rescheduled.

 

[razztazz]

You state this in a manner that sounds like it is debunking the whole article - "one of the bogus statements."

Incorrect. Didn't mean to sound that way. Not writing "For the Ages" here.

 

[imoldernu]

Sigmoidoscopy then sigmoid resection 25 years ago Therein lies a short story.

Now, unless symptoms of anything show up... and a web search shows to be serious, try not to be invited into tests beyond the BMP, to adjust medications.

The single screening that will be taken over my dead body is the dementia diagnostic test. No positive benefits.

 

[Amethyst]

Dementia test results could be a way to convince someone that lifestyle changes will be needed, even if "I feel fine now."

Amethyst

S
The single screening that will be taken over my dead body is the dementia diagnostic test. No positive benefits.

 

[haha]

And mammogram as well - it's uncomfortable and potentially painful (pancaking your ta-tas is not the most pleasant experience and some techs are VERY aggressive about squishing the plates as tight as they can.) But it's non-invasive... no skin is broken, etc... but some women have dense breast tissue and that might lead a doctor to want to biopsy "just in case".

Ionizing radiation is definitely invasive. That is what allows x-rays to see beneath the skin.

Ha

 

[Rich_by_the_Bay]

1. Remember, screening implies that the patient has normal risk factors, history, normal general exam, etc. -- it may not apply to higher risk populations. Example: stress test for coronary disease in normal patients versus in patients with diabetes, 2 PPD smoker, strong family history of early sudden death.

2. A screening test itself may or may not create harmful results. It's the cascade of follow-up studies that cause worry, complications of biopsies, cost, that may not be useful for many patients. Watchful waiting may be more suitable in many cases. Example: PSA of 4 - 10 leads to prostate biopsy, occasionally to sepsis and rarely to death.

3. I am not sure that "I knew a guy once who..." is a convincing argument in this context.

4. Similar issues exist for false negative results: the patient actually has the disease being screened for, but the screening test comes back "normal."

4. FWIW IMHO the best approach is often to discuss the risks and benefits of a test under consideration, engage in shared decision-making, and have a pre-test plan for the management of the screening tests performed, then stay the course.

 

[rodi]

4. FWIW IMHO the best approach is often to discuss the risks and benefits of a test under consideration, engage in shared decision-making, and have a pre-test plan for the management of the screening tests performed, then stay the course.

ITA with this.

 

[eytonxav]

Periodically, I see ads in our area for these full body scans and even have a friend that is convinced these tests are very important. It seems like a total waste of time to me, and he gets mad when i say that.

 

[redduck]

Reasons for a Falsely Elevated PSA include:
-recent digital rectal exam
-recent sexual activity or ejaculation


Since it's almost unheard of to have one without the other, shouldn't they just count as one?