To Screen or Not to Screen?
Recently in class we have focused on the utility of screening tests and how to determine whether or not the test will benefit or harm a specific patient. Before taking this class, I would have assumed that, in any case, knowing you have a disease or are at risk for a disease is beneficial. But after our recent discussion I can see that this is not always the case.
As one can imagine, knowing about certain diseases always puts the patient at better chance of survival (as with breast cancer, skin cancer, etc.). One of the most popular examples used to demonstrate how knowledge can be harmful to the patient involves prostate cancer screening. My father is a recent survivor of prostate cancer. I was shocked to learn that screening for PSA (prostate specific antigen) isn't always the right choice for every patient being treated. While in some cases, as with my father, screening is lifesaving, we learned that in several cases it can lead to more invasive testing and unnecessary treatment that will negatively affect the future quality of life for that patient. In cases when screening was harmful--when the cause of a patient's problems was benign or if the disease was so extremely slow moving that it wouldn't have led to death within that patient's lifespan--it was obvious why screening everyone across the board isn't always the right choice to make.
When it comes down to it, screening for a disease is difficult to do for the general population, because the true usefulness of a screening test depends on the outcome for each specific patient, thus taking us back to the individual. I'm beginning to realize that while so much of medicine is pure knowledge--the application of tests and interpreting results--an even greater part is remembering that each individual patient is different and should be treated that way.
In other words, while screening for some disease may be good for some of our patients, it may not be the best choice for others. As health care providers, it will be our job to offer what we know or what we are continuing to learn to each patient so that together we can make the right choice for their future health as individuals.