Medical screening tests: too much information?

January 15, 2002|By Jim Sollisch

CLEVELAND - The last time my mother was at the doctor was when my brother was born - which was at the end of the Eisenhower administration.

Now that's not such a long time ago to be born, but it is a long time between doctor visits. My mother is 70, and except for a persistent recurring irritation caused by her family nagging her to go to the doctor, she's feeling fine.

In fact, she's never felt better after reading an article last week that questions the wisdom of screening healthy people for cancer. The piece was sparked by the findings of scientists in Denmark who analyzed several mammography studies and found that mammograms did not lower the overall death rate from breast cancer.

The prevailing medical wisdom has been the more you know about your body, the healthier you'll be. It was the kind of wisdom almost none of us could question. But new studies are finding that when you screen healthy people, you almost always find something suspicious. A doctor who has written on the drawbacks of screening tests says one way to define a healthy person is "someone who has not been completely worked up."

A recent study at the Mayo Clinic used a new technology called spiral CT lung scanning to screen more than 1,500 smokers. Thirty-seven malignant tumors were found. But so were 2,800 suspicious lumps. Ninety percent of the group was found to have something that might warrant further investigation, requiring surgery, which itself carries a 4 percent risk of death. In the end, Dr. Stephen Swensen, who directed the study, concluded that many of the group suffered needless operations and medical procedures.

I think my mother intuitively knows that omniscience is not something we should aspire to. Once when I was in college, I was home with one of my roommates and we started telling my mother about some of our escapades. She excused herself from the room, saying, "I don't have to know everything you do."

Imagine the drawbacks of knowing too much in other, non-medical, aspects of your life. What if you could screen your spouse and know every impure thought, every flirtation? Most couples couldn't last a week. We humans are incapable of having knowledge and not acting on it. Accusations would fly, appointments with divorce attorneys would be scheduled. Your marriage would be needlessly damaged as a result of too much information.

As Edward Tenner points out in his book Why Things Bite Back, advances in technology almost always produce unintended and often negative consequences. Bike riders are suffering more injuries as helmets get better because the added confidence causes people to ride more recklessly. We wipe out tuberculosis in developed countries and then it reappears, resistant to antibiotics and even more deadly. Computer networks increase productivity but at the same time we have to hire armies of technicians to maintain them.

Measured in the context of this book, the notion that more screening can cause more harm seems pretty logical.

Most doctors are not proposing we give up on screening. But they caution that all the risks and benefits should be discussed and that screening should be used more selectively. Somewhere between full-body scans for healthy people and my mother's approach of seeing a doctor every 40 years, we should be able to strike a balance.

Jim Sollisch is a free-lance writer who lives in Cleveland.

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