2.0 Body of Contents
2.1 Over-diagnosis – a common issue in many screening tests
Many health screening tests tend to produce false positive results, or find abnormalities that may not cause any harm at all to the patient. This can cause distress to patients and their families and lead to unnecessary treatment.
For example, around 6-10% of mammogram results are false positives, meaning the images show what appear to be tumors but are actually cysts or harmless tissues. This estimate may be higher in younger women, as young women have denser breast tissues which may be difficult to scan as compared to women over 50, whose breasts are mainly composed of fatty tissues (Geraci, Gordon, Gower, Harrar & Paturel, 2008). Screening for dementia produces results that are even more inaccurate - 23% of results are false positives. So even if a patient has received a positive result from the test, the chances of him having dementia are very little – only around 17%. Generation of such false positive results causes unnecessary distress to patients as well as their families (McCartney, 2014).
Moreover, the generation of positive results often leads to even more tests and subsequent treatment. In cases where the positive results are actually false, the patient might end up taking tests and treatments that are not necessary (“When to say,” 2012; Dixon, 2013; McCartney, 2014). Breast cancer screening is a noteworthy example – As mammograms tend to pick up tumors whose effects cannot be immediately fathomed, doctors simply treat all tumors, regardless of whether they are cancerous or not. Such treatments often involve mastectomy and radiation therapy, both of which can harm the patient indirectly. If the tumor detected is cancerous, such risks are wo...
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Geraci, R., Gordon, D., Gower, T., Harrar, S. & Paturel, A. (2008). What works, what doesn’t. Pleasantville, NY: Reader’s Digest.
Mc Cartney, M. (2014, January 3). Patients deserve the truth: Health screening can do more harm than good. The Guardian. Retrieved from http://www.theguardian.com/science/blog/2014/jan/03/patients-truth-health-screening-harm-good
Monastyrsky, K. (n.d.). Side effects of screening colonoscopies. Retrieved from http://www.gutsense.org/crc/crc_side_effects.html
Pittman, G. (2013, January 3). Many people unaware of radiation risk from CT scans. Reuters. Retrieved from http://www.reuters.com/article/2013/01/03/us-many-people-unaware-of-radiation-idUSBRE9020OV20130103
When to say ‘Whoa!’ to doctors. (2012, June). Consumer Reports Health. Retrieved from http://consumerhealthchoices.org/wp-content/uploads/2012/05/ChoosingWiselyWhoaPkg.pdf
the effective doses from diagnostic CT procedures are typically estimated to be in the range of 1 to 10 mSv. This range is not much less than the lowest doses of 5 to 20 mSv estimated to have been received by some of the Japanese survivors of the atomic bombs. These survivors, who are estimated to have experienced doses slightly larger than those encountered in CT, have demonstrated a small but increased radiation-related excess relative risk for
Martin, Ian; Carey, John; DeCoster, Karen. (2009, June 1). A national study of the current status
7. Rhodes, J., Chan, C., Paxson, C., Rouse, C. E., Waters, M. and Fussell, E. (2010), The Impact of
The results of the study were consistent with the findings of other studies of the same nature on the effectiveness of breast self-examination in detecting and curbing breast cancer. According to a report compiled by Nancy Baxter in Canada, there was no evidence of significant benefit of breast self-exam on breast cancer cases in women of various age groups (2001). The study also found that there was considerable physical and psychological harm associated with breast self-exams. A different study by Hackshaw and Paul also found no significant difference in the number of breast cancer deaths between women who had been taught how to perform breast self-exams and those who did not perform the exams (2003).
Wald, M. L. (2010 , January 8). Cancer Risks Debated for Type of X-Ray Scan. Retrieved February 5, 2010 , from the New York Times: http://www.nytimes.com/2010/01/09/health/09scanner.html
Siegel, L.J., Brown, P., & Hoffman, R. (2013).CRIM 2nd edition. Toronto, Canada: Nelson Publishers. pp. 203-205
Early detection is the key to life after Breast Cancer. Effects that help to early detection goes as the fallowing; Yearly mammograms, Clinical Examinations, and checking yourself monthly. “Mammograms are a specific type of imaging that uses a low-dose x-ray system a...
Many people think if they do not feel any lumps in their breasts there is nothing to worry about. That is not always the case. “Mammography remains the “golden standard” screening method for women…and reliably identifies malignant tumors, especially those that are too small to feel (“Advances in breast imaging”). “Checking one’s own breasts for lumps or other unusual changes is called a breast self-exam, or BSE. This type of exam cannot replace regular screening mammograms or clinical breast exams. In clinical trials, BSE alone was not found to help reduce the number of deaths from breast cancer (cancer.gov)”. Mammograms are necessary because performing a self-exam does not always find what is there. Although self-breast exams have been known to catch lumps in the breast, mammograms have found more due to the fact that they can detect very small cancer much sooner than self-breast exams can. Also not very many people know how to correctly administer a self-breast exam. It is recommended that if you do perform self-exams you should also get routine mammograms. If you rely solely on self-exams, it may be too la...
Mammograms are only part of a complete breast exam. Do not rely fully on the results one would receive because false negatives can happen as well as false positives. Keep in mind to perform a breast self-exam on yourself at least once a month. In addition, even though mammography can discover the existence of tumors that cannot be felt, finding a tumor – no matter the size – does not always mean a woman’s life will be saved (Mammography, 2013). If the woman has a fast growing cancer that has already spread to other parts of her body before it was found, it may be too late. Yes, mammograms use radiation but they use very little of it. As mentioned before, it is the x-rays that have to be repeated that can cause cancer. So do not worry too much or panic. Just talk to a doctor about when to start and how often to have a mammogram (ePublications, 2013).
Informed consent is a very serious decision a patient has to make when it comes to their health and consenting to procedures that are believed to cure or treat their current health status. It is important to address the effectiveness of the role a physician play in the informed consent process assuring that the patient has given truly informed consent and what safeguards can be put in place to assure the patient is exercising informed consent. Informed consent is based on the fact that the person consenting is a rational individual that is aware of the action to which he/she is consenting. Allen and McNamara (2011) notes that "On the standard understanding, the important elements of informed consent are the provision of information, the voluntariness of the choice and the competence of the chooser to make the choice— so the potential research participant should be provided with information relevant to the decision to participate, they should be able to choose freely about their participation and they should be competent to decide.
Stewart-Brown, S. and Farmer, A. (1997) Screening could seriously damage your health BMJ; 314: 533
Prenatal testing is a test offered to pregnant women in their first trimester. These tests are often performed but for most of the findings there is no cure like for Down syndrome (Latendresse; Denenis, 2015). Most tests are performed in order to find a cure. However, prenatal genetic testing is mostly used for informative reasons. The test can only detect the high risk of a problem. Most of the time it is not used for diagnosis. Most prenatal tests are sensitivity test leading to false-positive results. Some test can be misleading. Some prenatal test is linked to the risk of pregnancy loss (Latendresse, Denenis, 2015). The risk with a test that is not 100% positive will always raise the question, is it really worth it in the end.
There are many different ethical challenges with colorectal screening, from access to care, screening methods, and treatment options. Not every person has equal access to preventative care. Education about colorectal cancer screening and access to screening tests varies by geographic location. Screening for colorectal cancer is lowest in the areas with low socioeconomic status (Macrae, 2015). Not all colorectal screening methods are available for people worldwide, so many people do not get to choose what method they want or would be medically best (van Dam & Bretthauer, 2014).
Genetic testing, also known as screening, is a rapidly advancing new scientific field that can potentially revolutionize not only the world of medicine, but many aspects of our lives. Genetic screening is the sequencing of human DNA in order to discover genetic differences, anomalies, or mutations that may prove pathological. As genetic screening becomes more advanced and easily accessible, it presents society with difficult questions that must be asked about the boundaries of science and to what degree we are allowed to tamper with the human genome. To better understand the potential impact of genetic screening on our society, we must examine the potential benefits in comparison to the possible negative impact it may cause. With this knowledge in hand, we can examine what the future holds for this field of study and the best possible direction to take.
Mammography is a very accurate screening tool for women at both average and increased risk; however, like any medical test, it is not perfect. Although the majority of women with an abnormal mammogram do not have cancer, all suspicious lesions that cannot be resolved with additional imaging should be biopsied for a definitive diagnosis. Breast cancer screening for women at average risk includes clinical breast exam and mammography. This screening tool can often detect breast cancer at an early stage, when treatment is more effective and a cure is more likely (cancersupporttexas.org, 2015). Statistics from the Centers for Disease Control shows that lack of mammography screening is the main cause of