Diagnostic Screening Tests can Save Lives but Sometimes Pose Risks

Modern medicine offers diagnostic screening tests that can save lives by detecting dangerous diseases when they are at their very early stages when they can still be treated. These include early screening for heart disease and various types of cancers. According to the Centers for Disease Control and Prevention (CDC), heart disease is the number one leading cause of death in the United States and cancer follows closely  in second place. Detecting these diseases in their early stages when they can be treated can save lives and years of suffering. However some of the screening tests actually carry risks for dangerous reactions and side effects that can be just as dangerous, if not more dangerous than the diseases themselves. In fact, while many people are found to be free of the disease that was being screened, nonetheless they can be left with dangerous and even life threatening problems that might even lead to an unexpected early death.

Exposure to Radiation is also a Risk for Cancer

Ironically, many of the screening tests for cancer involve exposure to radiation which may in itself trigger the onset of a malignancy, awaken a dormant cancer and aid in the spread of this dread disease. Doctors have to weigh the risks of the screening against the risks of the diseases and take a person’s medical history and current medical conditions into consideration when making the decision to send someone for diagnostic screening that uses radiation. MRI scans do not have any radiation, but as they are more expensive than CT scans, they are not always used.

The AARP Addresses the Question about Which Tests are Really Necessary for Seniors

A recent article in the AARP newsletter addresses this question concerning which medical tests you really should get and the fact that some screening tests may do more harm than good. Unfortunately, statistics do not list people who suffered injurious complications or even death from the screening tests.

The AARP begins with discussing the plight of a California woman who was offered a free heart scan. Before she took the test, however, she had to sit though a long video presentation that played on fears about unseen cancers and undiagnosed dangerous heart conditions and the video suggested purchasing a whole battery of diagnostic screening tests for $5700. After she took the heart scan she was told she needed urgent catheterization, which though often necessary, also carries risks and dangers. She then went to her own doctor who sent her to a cardiologist who sent her for several non-invasive tests that showed she did not need to do a catheterization. Unfortunately, besides being exposed to large amounts of radiation, the screening results were on her medical records and she was refused life insurance.

The US Preventive Services Task Force (USPSTF)

The AARP lists the diagnostic screening tests recommended for seniors by the United States Preventive Services Task Force (USPSTF). The USPSTF is an independent group of national specialists in primary care that are authorized by Congress and they are the main source that doctors rely on for screening recommendations.

Screening Recommendations by the USPSTF

The USPSTF Grades Screening Recommendations as A, B, C, D, etc.

Colonoscopy/Sigmoidoscopy

Grade A for adults from age 50-75

Grade C for seniors from age 76-85

Colorectal Cancer

Colorectal cancer is the 4th leading cause of cancer in the United States and one of those nasty silent ones that do not cause symptoms until it is well advanced and sometimes it is too late to treat. For this reason early screening is encouraged by doctors. Many people have benign pre-cancerous polyps, which can usually be easily removed before they turn malignant (cancerous).

The sigmoidoscopy is a narrow flexible tube that is inserted in the anal canal to examine the rectum and sigmoid colon where most cancers occur. According to the USPSTF, sigmoidoscopy screening reduced overall deaths by 2.5% (2 to 3 lives saved for every 100 people who were scanned).

Colonoscopy examines the entire colon, but has not been shown to reduce deaths overall, probably because 1 in every 220 people who undergo a colonoscopy get serious complications.

Most Doctors Prefer Colonoscopes

Most doctors prefer to send their patients to colonoscopes which will check the entire colon (bowel) for pre-cancerous polyps or tumors rather than for a sigmoidoscope which checks only the s-shaped sigmoid colon. While most polyps and tumors are found in the sigmoid colon, nonetheless, there are also cases where polyps and tumors are found in the rest of the colon. In fact, during the colonoscope the doctor can usually remove any polyps that are found, unless they have grown too big to be easily removed this way.

Complications from Colonoscopes

The problem is that a full colonoscope carries with it risks and it is a very uncomfortable procedure for most people and they may need some form of anesthesia. Some people get a severe allergic reaction to the anesthesia. Other colonoscope risks are significant, such as perforation of the bowel which can lead to life-threatening infections and lifelong complications. People with inguinal and femoral hernias are at high risk for complications, as the colonoscope sometimes gets incarcerated in one of the intestinal loops. If your doctor recommends a colonoscope be sure to inform him/her about any hernias you have or any you had in the past.

Non-invasive Fecal Tests for Colorectal Cancer

Non-invasive fecal tests check a stool sample for DNA evidence of active cancer and also check for minute traces of blood, which may indicate the presence of a cancerous polyp or tumor. However, if you get a positive result for either blood or for DNA evidence of cancer, you will still have to undergo a colonoscope to remove polyps and to see if there is in fact also a tumor. Most tumors are treated surgically and biopsied to see if they are cancerous or still benign (non-cancerous). People who suffer from hemorrhoids though are not usually sent for fecal tests, as the hemorrhoids also can be a reason for finding traces of blood.

Check with your doctor about what kind of screening options are suitable for you, especially if there is family history of colorectal cancer.

Mammogram

Grade B for woman ages 50-74

Some studies show that mammograms may lower the number of deaths from breast cancer, but there is no evidence that they reduce overall deaths for women of any age. A meta-analysis of 600,000 women showed no benefits for the screening. Breast cancer is the most commonly found cancer in the United States.

False Alarms

False alarms from mammograms occur to about 50% of American women. Mammograms can make serious errors of misdiagnosis. Some women are sent for unnecessary biopsies and even surgery to remove lumps or the entire breast when in fact they do not have cancer at all. On the other hand, there are cases of aggressive breast cancer that the mammograms miss and this can lead to death.

Mammograms Increase Risks from Radiation

Mammograms are also painful for many women, as they compress the breasts and also there are risks from radiation. In fact, some doctors believe that a yearly mammogram can lead to breast cancer.

MRI is Safer

In general, MRI scans are safer than mammograms, but are much more expensive. Check with your doctor about what options there are, especially if there is a family history of breast cancer.

Exams by Surgeons and Self-exams

Lumps can be detected by surgeons and also all women should learn how to do self-exams of their breasts.

Prostate-specific Antigen (PSA) Test

Grade C for men ages 55-69

Grade D for men age 70+

PSA testing has been shown to lower the rate of deaths from prostate cancer, but there is so far no evidence to show that PSA testing can result in an overall reduction in deaths for men at any age. Studies show that about half of all men will have some prostate cancer cells by age 60 and 70% of them will develop cancer by age 80, but only 3% of men will die from it.

Complications from PSA Tests

The PSA test results can also lead to complications. For instance, biopsies to check for cancer can sometimes lead to infections. Surgery, radiation and chemotherapy also can have serious complications and lead to incontinence and impotence.

Check with your doctor about the options for screening for prostate cancer.

CT Scan for Lung Cancer

Grade B for adults ages 55-80 who smoke

If you are or were a heavy smoker and you have a cough or are short of breath, then see your doctor right away. Smokers are not only at high risk for lung cancer, but also for chronic obstructive pulmonary disease (COPD,) which can be from emphysema or chronic bronchitis. A study of a low-dose CT screening test estimated that 12,000 lives could be saved, although about 27,000 people could get serious complications from some kinds of follow-up procedures.

PAP Smear Test for Cancer of the Cervix

Grade A for women ages 21-65

Grade D for women over age 65 or who have had a hysterectomy

Coronary Artery Calcium Screening

Grade I (Indeterminate)

Most patients who get high calcium results do not die prematurely from a cardiovascular event such as a stroke or heart attack and some who show zero calcium actually have serious coronary artery blockages.

Short or Long-term Rehabilitation and Skilled Nursing Care

If you or your loved one are in need of rehabilitation or long-term skilled nursing care the Van Duyn Center for Rehabilitation and Nursing in Syracuse, New York has a warm and dedicated staff and offers both short and long-term rehabilitation. There is an expert respiratory wellness department. They also have an array of recreational therapy programs.

Conclusion

Take all the diagnostic screening tests that are non-invasive and safe and have no potentially dangerous complications. For those tests that can cause dangerous complications, get at least two medical opinions.