You Think All Screening Tests Must Be Good?

Getting medical screening tests must only be a good thing, mustn’t it? It might find some cancer or other condition that would be missed otherwise?

What The Wags Call "An Acute Remunerative Procedure."

What this idea doesn’t take account of is that testing can lead to, not only pain, anxiety and expense, but lethal complications.



Colonoscopy for example “has not been shown to reduce overall deaths”* notes medical writer Jeanne Lenzer in an article ‘Which Medical Tests Should You Get?’http://( in the November issue of the AARP Bulletin.


Or, screening for for prostate cancer is not as strait forward as you might think. She quotes Kenneth Lin, M.D. professor of family medicine at Georgetown University Medical Center noting no study has shown a decrease in overall mortality with prostate specific antigen (PSA) screening for men of any age because “any prostate cancer benefit was offset by deaths and complications from biopsies, surgery, radiation and chemotherapy.”


There are “scan-in-a-van” companies and others offering vascular screening and other tests, drumming up business with non-recommended procedures. Discuss with your doctor any tests that are proposed says Lenzer.


Also, see if they are recommended by the USPSTF (U.S. Preventive Services Task Force – who are the impartial arbiters of what tests are good to get done. They rate them from A to D, or I for insufficient evidence).

Not Necessarily As Good As You Might Think.


Lenzer lists the recommendations for mammogram, PSA, colonoscopy/sigmoidoscopy, pap smear, CT scan for lung cancer and coronary artery calcium screening (a “very imperfect measure” she says of this).


I recommend anyone contemplating any kind of screening test read this article.





*Sigmoidoscopy, the older, less invasive exam where only the lower ‘S’ shaped part of the large intestine is examined, but where most colon cancers occur, hasbeen shown to reduce overall death rate (saving 2.5 lives for every 100 people screened).


But. . . .she quotes Kenneth Lin, as noting “flexible sigmoidoscopy provides comparable benefits, with less harm, and can be done in the office by modestly paid primary care physicians.” However, it is being phased out in favor of screening colonoscopy which “maximizes profits for hospitals and highly paid subspecialists” - afeature of “the profit driven monstrosity that is the U.S. health system” he notes.






2 Responses

  1. Patrick: I read your articles with great interest and I like to think I share your viewpoint (most of the time). Would like to correspond with you. Did you see the recent study showing the near 17% "complication rate" for screening chest CT, something I have always opposed?
    • Dr. Patrick Neustatter
      Glad to hear you agree with at least some of my ideas. Would be happy to hear more about your take on screening test - as I say, the usual response is "any test must be good" and people down understand the downside. Will try to find study about chest CT's - which seems something that is being promoted for screening.

Leave a comment