Screening

14 Jul

It’s not EM but it is interesting

I was brought up with the idea that screening was a great and really important thing. There’s been some recent criticism and some emotionally charged response. The idea that screening is a magic and wonderful thing fuels the mythic ideas that in popular culture about tests being a good thing; “just to be sure”.

This spills over into our practice with expectation levels rocketing in ED patients who think they need this or that CT or test “just to be sure”.

There are of course plenty of good reasons to do tests but it’s good to be aware of what our patients believe about tests.

Back to screening. Let me give you this as an example:

Effect of Screening on Ovarian Cancer Mortality JAMA. 2011;305(22):2295-2303 PMID 21642681

  • Randomised to either yearly TVUS and CA-125 or usual care
  • 40000 in each group
  • rate of ovarian cancer detection higher in screening group (212 v 176) but deaths from cancer were actually higher in the screening group
  • overall death rate was 2924 vs 2912 over 13 years favouring usual care 

Here’s a few other trials if you’re interested.

Randomised prostate cancer screening trial: 20 year follow-up BMJ 2011;342:d1539 PMID 21454449

Effect of Screening Mammography on Breast-Cancer Mortality in Norway N Engl J Med 2010;363:1203-10. PMID 20860502

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