AJPM commentary asks: How much health screening does a person need?
|July 09, 2013|
A commentary by Gillings School of Global Public Health faculty members, published July 9 in the American Journal of Preventive Medicine, addresses the controversial question of how much medical screening is enough.
Authors of the article, “The Times They (May Be) A-Changin’: Too Much Screening is a Health Problem,” are Russell Harris, MD, MPH, professor of medicine, adjunct professor of epidemiology and director of the Health Care and Prevention Master of Public Health degree program in the public health school’s Public Health Leadership Program, and Stacey Sheridan, MD, MPH, associate professor of medicine and adjunct associate professor in the Public Health Leadership Program.
Screening has been a key proponent of disease prevention for more than 50 years. However, Harris and Sheridan note the “growing chorus of voices that suggest a coming change in the attitudes of the public and the profession” in regard to screening. Various movements that include members of reputable organizations and medical boards (e.g., the American Board of Internal Medicine Foundation’s “Choosing Wisely” campaign) aim to reduce “waste” in the health care system by reducing the frequency and comprehensiveness of screenings for breast, colorectal, prostate and cervical cancers.Those who denounce annual or intensive screenings find problematic the financial, psychological and physical costs of procedures that may yield false positives and take time from other health challenges that should receive greater attention. With cervical cancer screening, for instance, the authors say that screening every three years retains about 95 percent of the benefit of annual screening while reducing harm (inconvenience, pain, fear) by two-thirds.
“Bob Dylan sang about changing times before they actually changed,” the authors write, “yet his singing moved the public discussion in a positive direction. Our sense is that the right song for the current discussion is about helping people come to appreciate the harms screening does to real people and how less-intensive screening can reduce those…and move us toward a better balance of benefits and harms.”