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February 19, 2015

Screening: More Does NOT Equal Better

Summary:

It isn't just diseases that cause epidemics. There can be an epidemic of diagnosis, too -- screening can do more harm than good.

Photo Courtesy of Alison Young

In an important op-ed piece in the New York Times, “An Epidemic of Thyroid Cancer?”, Dr. H. Gilbert Welch from Dartmouth University wrote that he and his team of researchers found that the rate of thyroid cancer in South Korea has increased 15-fold!

15X! How can this be?!

Were South Koreans exposed to massive amounts of radiation? Did South Koreans start using some dangerous skin product?

No. And no.

South Korean doctors and the South Korean government encouraged increased cancer screening. More screening must be better, right?

No. Not at all…

This is an important concept for employee benefits professionals to understand: More screening is not necessarily better.

What happened in South Korea is that the thyroid cancer had been there all along, just undetected. The most common type of thyroid cancer — papillary thyroid cancer — is usually very slow-growing, and people with this cancer never know it is there. It does not affect their health, and it does not kill them. According to the article, it is estimated that 1/3 of ALL ADULTS have thyroid cancer.

Thyroid cancer screening is performed by an ultrasound of the neck. It is an un-invasive, painless, fairly simple test. So what happened in South Korea was not an epidemic of thyroid cancer but, as the article puts it, “an epidemic of diagnosis.”

There is potential harm in treating a cancer that will likely not cause you any problems. Two out of every 1,000 thyroid surgeries result in death. Removal of the thyroid means a person will have to take thyroid replacement medication for the rest of her life. This medication can be hard to adjust, leading to problems with metabolism, such as weight gain or low energy.

In the U.S., there are many screenings that the U.S. Preventive Services Task Force has deemed “unproven” for application across entire populations of asymptomatic individuals. For example:

  • Screening the skin for skin cancer
  • Screening the carotid arteries (neck blood vessels) for narrowing

It is important to address the converse. Increased screening that has been shown to reduce morbidity and mortality is a good thing. Screening for high blood pressure is a good thing. Screening for diabetes is a good thing. Screening for certain types of cancers is a good thing.

What does this mean for the employee benefits professionals and the healthcare consumer?

  • Beware of “blanket” statements that more screening is better or of companies that are offering screenings that are not vetted.
  • Know that screening can actually cause harm because of side effects or complications of treatment for a “disease” that is really not a problem.
  • As you set up prevention programs for your employees, ensure that those programs are based on scientific evidence.
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About the Author

Eric Bricker, MD, a board-certified internal medicine physician, serves as the chief medical officer for Compass Professional Health Services. He co-founded Compass with Scott Schoenvogel and Cliff Sentell in 2005 to help change how healthcare is delivered to improve employee health and lower healthcare costs.

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