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While it might seem smart screen for any disease you believe you're at risk for, some tests can do more harm than help when they’re used in healthy people who show no signs of illness.
Basically, screening tests that have a lot of false positives can lead to lots of other tests, some of which can be invasive. Further, experts say, false positives can create anxiety and stress while the patient waits for the results of further testing.
“You have to weigh in the potential harm, whether it’s financial harm to the patient or payer, emotional harm to the patient or physical harm to the patient,” says Dr. Mylynda Massart, a professor of family medicine at the University of Pittsburgh Medical Center and medical director of UPMC’s Matilda Theiss Family Health Center. “You have to think about the downstream consequences.”
Many doctors think you don't even need an annual physical.
So here’s a list of tests that you probably should avoid if you’re healthy and have no symptoms of the disease for which the patient is being screened.
Heart risks are often under-diagnosed in women, so women may be encouraged to have an electrocardiogram to reveal hidden problems. However, the United States Preventative Services Task Force recently advised against this test in people who are at low risk of heart attack or stroke. The USPSTF even went so far as to say there wasn’t solid evidence for or against EKGs in people who were at intermediate to high risk, but who had no symptoms.
That doesn’t mean the tests have no use, says Dr. Thomas Gaziano, an assistant professor of medicine at the Harvard Medical School and the Harvard School of Public Health. “They are useful for diagnosing conditions, like atrial fibrillation,” or abnormal heart rhythm, Gaziano says.
Yearly blood tests
“People come into the office for their annual exam and they expect their doctor to order the standard panel,” Massart said. “But the chance that you’ll identify an abnormality this way in the absence of any symptoms is extremely low."
Massart favors of age-based screening: a onetime screening test after age 40.
"Then, as you move forward, you consider the patient’s risk factors,” Massart said.
If there are no risk factors, patients should be tested once every five years for cholesterol and once every three years for blood sugar.
“But if you have high blood pressure or you’re obese, then testing for diabetes is warranted,” said Gaziano.
Whole-body MRI scans
Is there a disease in your future? Whole-body MRI scans are promoted as a way to diagnose diseases like cancer before normal screenings can detect them. The problem, an MRI may "see" something that looks abnormal but may never develop into something more serious.
“These are tests we shouldn’t be doing,” said Dr. Lenny Feldman, an associate professor of medicine and pediatrics at the Johns Hopkins Health System and co-director of Hopkins High Value Care Committee.
Exercise Stress Test
A recent survey showed that in the last five years one in eight asymptomatic Americans between the ages of 40 and 60 were getting heart stress tests, says Dr. Roy Ziegelstein, a cardiologist and professor of medicine at the Johns Hopkins University School of Medicine.
“There are huge costs associated with that,” Ziegelstein says. “And there’s a potential for false positives that could lead to more downstream tests.”
Prostate Specific Antigen (PSA) test
Most men can skip the PSA test, experts say.
“Over the past decade we’ve learned that the potential for false positives and all their downstream consequences far outweigh any benefits that might come from using this test,” Massart says. “But there may be certain individuals for whom the test is more appropriate, such as men who are at higher risk of prostate cancer. This would include African American males or men with a strong family history of prostate cancer.”
While still controversial the PSA blood test can save some men's lives from prostate cancer — for every 1,000 men screened, one to two lives were saved, according to recent research.
Rather than just jump to screening, every man between the ages of 55 and 69 is advised to talk to their doctors about taking the test, according to recommendations released last year by the USPSTF.