Dr. Lawrence Goldyn is the medical director at Mendocino Coast Clinics, a non-profit, federally qualified health center serving as a patient-centered medical home for people on the Mendocino Coast. MCC provides a team-based approach to care, offering medical, dental, behavioral health services, and more. Learn more at mendocinocoastclinics.org.
Medicine changes as science changes. In the case of annual screenings, we’ve discovered that more isn’t necessarily better.
In the past, well-meaning providers thought that if they screened patients for certain conditions, even without any symptoms present, the providers might be able to identify a disease early and treat it before it caused significant problems.
In theory, it sounds great, but in practice, it led to unintended consequences. When screenings are done without any consideration for individual risk factors, financial expense, or social/emotional costs, some screenings end up causing more harm than good.
In the past, some medical practices screened for heart disease with electrocardiograms (EKGs) on all patients over the age of 40 to offset the increased risk for heart attacks as people age. However, if we do EKGs on enough people, abnormalities will show up. Ultimately, most of those abnormalities may be of no importance, but once you find an abnormality, you feel obliged to pursue it.
Thus begins a journey down the rabbit hole. A perfectly healthy 40-year-old with a slightly abnormal EKG ends up getting a cardiac stress test, and potentially an expensive, invasive, high-risk procedure called a cardiac catheterization—all to find out they were fine all along. Never mind they’ve missed work, gone through terrible anxiety, and spent a chunk of their savings to end up no better off than they were to start.
Routine screenings aren’t worthwhile unless they’re likely to change the course of someone’s health. Screenings should meet three standards: They should be cost-effective, tolerable to the patient, and useful in mitigating disease. Otherwise, they put an undue burden on individuals and the whole healthcare system. We now know enough about who is at risk that we can recommend appropriate screenings based on age, sex, family history, and other risk factors.
Here are some of the routine screenings that are worthwhile because they are effective and specific, reasonably cost effective, might have a large impact on ongoing health, and involve acceptable treatment. Talk to your primary care provider to find out which screenings you need and when.
Breast cancer: All women older than 40 years of age should get regular mammograms.
Colon cancer: All adults older than 50 years of age should get screened periodically via a colonoscopy or at-home tests like Cologuard. (This will soon change to adults older than 40 years of age.)
Cervical cancer: All adult women should get regular Pap tests.
Prostate cancer: Screening for prostate cancer raises complicated issues. It is not clear that this screening meets the standards outlined above, but it does for some men: Black men and men with a family history of prostate cancer probably do benefit. Patients should discuss the issue with their medical provider.
Blood pressure: All adults should be screened regularly with a blood pressure cuff (and generally are whenever they visit a medical provider).
Diabetes and cholesterol: All adults should receive routinefasting blood sugar and lipid panels.
Bone thinning: Bone density tests are recommended for all women older than 65 and for younger women with risk factors.
Depression: All adults should answer the depression survey questions periodically. Depression can be life threatening. It is easy to screen for and we have good interventions available.
Substance use: All adults should be screened regularly for the use of tobacco, alcohol, and other drugs.
Bloodborne infections: All adults should be screened at least once for Hepatitis C and HIV.
Clearly, if we do not screen for every possible disease, we will miss some cases; however, the damage to thousands of people who would be screened unnecessarily comes at too high a cost. Also, our healthcare system has limited resources, so those resources should go where they can do the most good. When patients come to Mendocino Coast Clinics for a routine visit, we review their chart before they arrive to determine which screenings they should get based on their individual risk factors. This keeps them as healthy as possible and reduces the burden on our overtaxed healthcare system.
