The Times They (May) Be A-Changin’

Abstract

248 Am J P The appeal of screening for both the public and the medical profession has been a dominant force in prevention for the past 50 years. The general trend toward increased intensity of screening—screening more people with more sensitive tests more often—has continued seemingly unfazed by the occasional objections of some. Until now. Of late, there has been a growing chorus of voices that suggest a coming change in the attitudes of the public and the profession. Although the reasons are not clear, the media regularly discusses “waste” in the healthcare system, that we are testing and treating more than we need. Books for both the public and the profession have discussed overdiagnosis and overtreatment as a result of too much testing and screening. Consumer Reports has teamed up with the American Board of Internal Medicine Foundation to develop a “Choosing Wisely” campaign (consumerhealthchoices.org/campaigns/choosing-wisely/). Journal articles have even started using the term “harm” for the adverse events that come from medical interventions. And the U.S. Preventive Services Task Force (USPSTF), sometimes joined by other professional and advocacy groups, has continued to recommend less screening for breast cancer (every other year rather than annually, starting older and ending younger); colorectal cancer (may use approaches other than colonoscopy, should stop at older ages); prostate cancer (stop screening altogether); and cervical cancer (start at age 21, screen every 3 years, stop at age 65 or after hysterectomy). The new message from all of these sources boils down to this: Screening is not the unqualified good that we have advertised it to be. It has clear potential harms as well as benefits, and these must be carefully weighed before a rational decision about screening can be made.