Weigh preventive screenings' cost-benefit ratio

Ethics Forum. Feb. 6, 2006.

Scenario: Which tests do you recommend, and what if a patient declines?

The public is constantly being urged to undergo screening. Ads in buses and subways hype oral cancer screening; radio and TV commercials tout full-body CT screens. What is a physician's best course of action?

Reply:

Every day, physicians see a significant proportion of patients for screening-related visits. Common reasons for the visits include discussing recommended screening tests, answering questions for patients at risk, and evaluating patients who have had a screening test with abnormal results.

The number of cases seen is due, in part, to the recommendations for screening publicized by many advocacy organizations such as the American Cancer Society and, in part, by the willingness of physicians to follow these recommendations. For example, many women's health and cancer-related organizations recommend breast exams beginning at age 20 and mammograms beginning at age 40. Many groups recommend prostate-specific antigen measurement and digital rectal examination for African-American men, for any men age 40 and older who have a strong family history of prostate disease and for all men older than 50. Among the many other diseases for which screening is recommended are hypercholesterolemia, hypertension, colorectal cancer, cervical cancer, testicular cancer and osteoporosis.

Though screening guidelines are undoubtedly always made by careful consideration of several experts and with the intention to help patients, the evidence supporting screening tests is not always strong.