Why doctors, insurers and patients grapple over cancer screenings
COM: I understand that those affect levels of risk. But look at it this way. Let’s assume I agree that costs should be contained, that the underserved need health care too, and so on, but I also really don’t want to let a tumor get past me undetected until it’s too late. Why would it not be in my best interest – my personal interest – to have every test there is, for every type of cancer? You brought in the distinction between seeing a population and seeing an individual. Could a screening test ever be a bad option?
Avery: Healthy living is the better option. And yes, too much screening can be bad for your health, for several reasons.
First of all, there are false positives. These include true false positive results in a test, but a lot are due to laboratory error. Over the years when I’ve chased some of these false positives down, it has usually ended up being a bad laboratory. You send the same test to another lab and it ends up being negative. A false positive means you may end up having an invasive and dangerous procedure you didn’t need.
Second, context matters. In most of these screening tests, we’re looking at biomarkers. When we’re looking at blood, we can see the red blood cells, and if there aren’t enough red cells you’re anemic. But let’s say you’ve got chest pain, and you draw blood for a biomarker and it shows muscle enzymes going up; that doesn’t automatically mean you’ve had a heart attack. You’ve got to do it in combination with an electrocardiogram and risk history.
COM: So the test itself does not tell the whole story.
Avery: Right.
No comments:
Post a Comment