Choices With Screening

Choices With Screening

Joy Stepinski, MSN, RN-BC

May 4, 2025

Over the past months, we have discussed that part of health decisions is avoiding too much medical care. In the book Less Medicine More Health: 7 Assumptions that Drive Too Much Health Care, Dr. Gilbert Welch presents seven assumptions that drive not only healthcare, but also public policy. We continue to consider these assumptions and how they may relate to one’s healthcare decisions.

The third assumption is that sooner is always better. This chapter examines screening, which is defined as searches for abnormalities without any presence of disease symptoms [1]. Preventive healthcare became popular in the 1970s during the Nixon administration’s “War on Cancer”. Instead of promoting lifestyle habit changes to prevent disease, the healthcare industry stressed the importance of early detection.

Screening may benefit some people. Yet screening may also lead to false positives, overdiagnosis, fear, and overtreatment. For example, screening may benefit the 8,000 Americans who die from oral cancer each year. On the other hand, oral cancer screening may lead to harm for the other 240 million American adults affected. The odds that screening could potentially harm someone to those who may benefit are 30,000:1. Other examples of screening are mammography, prostate exams, and colonoscopies.

How can you apply this to making a health decision? Consider that screening should have “sufficient benefit to warrant accepting possible harms” (p. 81). Ask if there are randomized controlled trials that demonstrate lower mortality. If there are not, pursuing screening would likely not have much benefit. If so, then consider how many people benefit and are harmed. Think about the potential of false positives and how that may be a factor in your decision. If you choose to be screened and the results are abnormal, Welch suggests taking your time. Consider waiting six months before retaking the exam. Seek out a second independent opinion. Informed decision-making is important to health!

Reference:

1.      Welch, H. G. (2015). Less medicine, more health: 7 assumptions that drive too much medical care. Beacon Press.