Monday, December 11, 2023

Is early detection and treatment always the best?

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Throughout my medical career, I have heard statements like these:

Early detection offers the best chance of recovery.

If you are waiting for the symptoms, you have waited too long.

Knowledge is power, and the sooner you have information the better.

Over time, I have realized that they are often wrong. Many health problems go away on their own. In such cases, early testing can be a waste of effort, time and medical expense. Some tests are invasive and present a significant risk of complications. And minor abnormalities can lead to more testing. There is also the anxiety of waiting for results or learning that you have an abnormality of uncertain importance that requires further evaluation.

Why wait? Why not just test and treat right away?

Sometimes the “cure” is the passage of time. This is one of the reasons why many doctors suggest watchful waiting rather than aggressive testing. Knowledge is power only if you can do something useful with it. And many conditions are not worth knowing or treating until they cause symptoms.

For these reasons, the American Board of Internal Medicine Foundation launched the Choose carefully in 2012. Its mission is to encourage more selective and evidence-based testing and treatment, and to discourage unnecessary testing and care.

Six conditions for which early detection and treatment are not clearly helpful

  • Certain leukemias and lymphomas. Although malignant, some leukemias and lymphomas can progress so slowly that the risks of treatment outweigh the benefits. For example, no therapy can be recommended for chronic lymphocytic leukemia it does not cause any symptoms.
  • Sarcoidosis. This condition of unknown cause often causes enlarged lymph nodes and inflammation of various organs. But in the absence of symptoms, a normal physical examination, and normal routine test results, no treatment can be warranted.
  • Certain types of Prostate cancer. For men with prostate cancer that has not spread outside the prostate and looks nonaggressive under a microscope, close monitoring without treatment may be advised. This recognition has led to uncertainty as to whether to screen for prostate cancer (for example, with a blood test called PSA).
  • Osteoarthritis. It is the most common type of arthritis and is almost universal with age. No treatment can be justified if the symptoms are mild.
  • Slightly elevated LDL cholesterol in people at low risk of cardiovascular disease. Healthy lifestyle recommendations like getting regular exercise, losing weight, and choosing a healthy diet are consistently recommended for this group, but medications are not.
  • the cold and many other viral infections. Our immune system is able to fight off most viral infections without drugs or other treatments. Treatment is usually limited to supportive measures (such as cold remedies, fluids, and fever reducers) and is not dependent on test results.

When not to wait: tests to rule out a serious diagnosis

When there is a significant suspicion for a serious disease in which early detection and treatment would have make a difference, your healthcare provider should do everything possible to figure this out as early as possible.

For example, if a chest x-ray reveals an abnormality suggesting cancer, a more in-depth evaluation should be arranged promptly. If no cancer is found, that’s fine – but that doesn’t mean the tests were unnecessary. Quick decision outside a worrying diagnosis that seems quite likely is often the reason testing is recommended.

What about peace of mind testing?

A person who is not feeling well and does not know why may be worried, anxious or even depressed. It’s easy to imagine the worst, even if you know it’s unlikely. Getting a diagnosis – or ruling out a diagnosis – can provide reassurance and relief that can be deeply helpful.

But often, insurance can be provided without extensive testing. For example, imaging tests like an MRI are not recommended when a person has recently developed back pain but does not have other symptoms or abnormalities on a physical exam because we know the chances of finding something serious are quite low. Extensive and expensive imaging is not necessary – and could increase anxiety unnecessarily if an incidental abnormality of no consequence is discovered.

The reassuring value of early detection has been exploited by those who benefit from it. Some imaging centers promote scans, ultrasounds and other tests without the intervention of your doctor. Terrifying ads detail horrible things could is happening in your body right now: aneurysms about to burst! Almost blocked arteries on the verge of causing a stroke! Enlargement of tumors about to spread throughout the body! Of course, these tests may not be covered by your health insurance, so these advertisements trick you into spending thousands of dollars for “peace of mind,” ignoring the evidence that these tests are generally not helpful and can cause harm. damage.

Some organizations offer their leaders medical tests in addition to the usual medical care. It is considered an executive benefit to have body scans looking for early illness to treat. Again, such tests have real drawbacks and in my opinion may not be a benefit at all.

Early detection and treatment can save lives – but not for all health problems

Certainly, there are many conditions for which the earlier the diagnosis, the better. This is because we have effective treatments that work best during the early stages of the disease. Breast and colon cancer, for example, can be cured if caught early enough. This is why screening tests, including mammography and colonoscopy, are so important: They have the potential to detect a tumor early before it has progressed to an incurable or even fatal stage.

There are also non-cancerous conditions in which early diagnosis and treatment improve outcomes: rheumatoid arthritis, appendicitis, and bacterial pneumonia are good examples.

The bottom line

The importance of early diagnosis and early treatment is clear for some conditions. But for others, it’s oversold. It could be argued that our ability to test has exceeded our ability to interpret the results. Just because we can testing hundreds of diseases doesn’t mean we should.

The culture of American medicine has long been “more care – and more testing – is better care.” But as we spend more and more on health care without proportional improvement in health, it is worth reconsidering this hypothesis. If you are unwell or have health problems, talk to your doctor about what to do next. But don’t be surprised if he doesn’t recommend any specific treatment or test. A plan to pass the time with close follow-up could save you the expense, anxiety, and risk of unnecessary care.

Follow me on twitter @RobShmerling

The post office Is early detection and treatment always the best? appeared first on Harvard Health Blog.


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