When to Stop Screening

 We have a lot of data on how and when to screen for certain diseases, particularly cancers, but relatively little on when to stop.  Many guidelines, such as those for mammography and colonoscopies, suggest 70 or 75 years of age, but this is somewhat arbitrary.  A particularly useful thing to think about, in my opinion, is the functional status of an individual in relation to ones perceived life expectancy.  By perceived life expectancy, I mean how long do you expect an individual to remain alive, especially with a reasonable quality of life, not a life expectancy derived from actuarial data.  The data would suggest that an 87 year old man will live for 5 years, but this is based upon a statistical estimate of the population at large.  I've met 87 year old men who I would not expect to live a week, and others that I would not be surprised to live to be a hundred.  I think this is important to consider when offering a screening test.  A woman in excellent at health at age 75 may very well benefit from a mammogram, and should be offered.  A woman in terrible health at age 65, with many serous diseases, may not.  A rule of thumb I use is "can I see this person living a good quality life for the next ten years?"  If the answer is yes, I think it is reasonable to offer a screening test. 

Comments

Post a Comment

Popular posts from this blog

MRI

 "Doc, my back hurts.  I need an MRI." The MRI seems to be the Holy Grail of diagnostic tests to many patients, especially for those with back pain. Its utility?  Virtually zero. As with most diagnostic testing, the question to ask is "What am I going to do with the information I get from the test?"  The answer, at least with MRIs order for back pain, is "Nothing." First, a bit about back pain.  In generally, if one does absolutely nothing - no medication, no physical therapy, no MRI, X-ray, CT scan, no massage, no acupuncture - 90% of those presenting with back pain get better in 30 days.  There are exceptions, those that require more aggressive therapy, and more urgent diagnostic testing - the so-called "red flags of back pain" - but those are ascertained by a good history and physical examination.  The majority of cases, though, are not serious, medically speaking.  For sure, back pain can be life interfering, but for the most part acute onset...
Read more

The Yearly Physical

 There has always been great interest in the “annual check up” or the “yearly physical.”  But do you know where this came from? In the early 20th Century, as the health insurance industry developed, the insurance companies felt it would be in their best interest if their customers were seen periodically by a physician. Their premise was that problems would be uncovered early, and that would reduce the number and dollar amount of claims they would have to settle, saving them money. (Remember, the mission of insurance companies is not to keep you healthy; it is to increase profit margins).  So they advocated the annual physical and so it has become entrenched in our society.  A myriad of studies, however, have never proven that this activity confers any benefit to the patient. The likelihood of uncovering a serious problem before the onset of symptoms is vanishing small. In nearly 40 years of practice, I’ve diagnosed exactly one problem, before there were symptoms, tha...
Read more