On September 15, Dr Lancelot Pinto, a pulmonologist and epidemiologist at Hinduja Hospital in Mumbai, shared a tweet: “In the name of being proactive, blood tests/imaging done by those privileged enough to afford them is unbelievable. I'm seeing 20 year olds getting a battery of tests done for a one day fever/cold. We need an audit of the quantum of tests done; probably the highest in the world.”
In an interview with THE WEEK, Dr Pinto said the context for his tweet was a young boy of 25 who consulted him for a "one-day fever." "He came to me with so many test and imaging reports, all of which were proactively done, that it baffled me. It just seemed ridiculous because he had no comorbidities and nothing else that could be a cause for concern. It was simply paranoia and overzealousness. Unfortunately, that seems to be the norm nowadays with people getting blood tests done even before they approach a doctor. So, the threshold for getting oneself tested is going really low."
Experts to whom THE WEEK spoke, agree that a high number of Indians are now getting self-testing done at the drop of a hat. No doubt health screenings are advisable because they help in catching diseases early, while it can still be treated; but they can also be a turn for the worse, caution doctors.
"Proactive screenings do help in picking up something early on, which can make a huge difference over time. Mammography is one such example. Periodic mammography is advised for women in their late 20s and 30s so that it is easier to notice lumps when they are really small. Cervical cancer is another example where screening with an HPV or Pap test once every three to five years from the age of 25 is recommended so as to nip cancer in the bud. But health screening is a very complicated subject in medicine. A successful screening test must meet certain criteria: One, confidence that the disease will be picked up earlier than normal, two, picking it up early must change the trajectory of the disease. Most times, neither of these two criteria are met," says Dr Pinto.
Doctors believe that more often than not, health screenings or proactively carried out testing lead to over-diagnosis, that is picking up diseases or conditions that were never going to cause any problem anyway.
For example, take the debate related to breast cancer screening which is advised for women in the ages of 20s and 30s to pick up on cysts early on. But the mammogram, carried out as a part of a routine test screening may find lesions of uncertain significance. In normal circumstances, the woman might have lived all her life with those tiny lesions in her body, but because it shows in the screening, she feels she is bound to get treatment for it which can include mastectomy and radiation therapy. These treatments can do harm.
This means that even when the screening has picked up a potentially harmless lesion, one might be triggered to initiate a high-impact treatment, thereby leading to multiple and unnecessary follow-up complexities. Hence, it is advisable to follow the concept of testing only when it is so prescribed, say experts.
"So, it is not that straightforward as thinking what is the harm in self-testing. There is a lot of harm if not done in the right context. There is a statistical concept that if you do 20 tests randomly, just by absolute probability, one out of 20 will come abnormal in 99.99 per cent times. Which is why when you go for a health check-up, no matter how healthy you feel, there will definitely be at least one test that will result in an abnormal range out of the multiple tests you do. The analogy here is if you throw a net, trying to catch everything, you will only get a lot of noise. But if you do it where the suspicion is high, then it is a true positive and you will end up with a high amount of catch."
So suppose one does a screening for the abdomen and finds a cyst. Now what will usually follow is a battery of further tests, treatments, and therapies. But experts ask what if one would never have found that cyst and could live her entire life with it smoothly without any problems? So, this means that screening only gives you unnecessary pangs, especially at a time when you are otherwise quite healthy, regardless of the cyst because you were unaware of its existence.
Then there is also the question of inaccurate testing during health screenings. For example, when it comes to testing at-risk people for dementia, the tests prove to be inaccurate as, in addition to picking those who have dementia, they also tend to identify a high number of people who in reality do not.
"Generating false positives and negatives comes with random and frequent health screenings which in turn creates anxiety. In many screenings, the parameters are still under research and haven't been well defined. So, for instance, lung cancer screening is riddled with controversies. There are an equal number of people who say that it does not save lives at all and they are trying to refine the criteria further over time. Earlier, the criteria was anyone who smokes for ten years, now it is raised to 30 years so as to pick up the right markers during a screening."
In the journal, Nature, Sigrid Carlsson, an epidemiologist at the Memorial Sloan Kettering Cancer Center in New York, said, “Used wisely, screening for breast and prostate cancer can significantly reduce an individual’s risk of dying from those cancers. However, the potential benefits may not necessarily outweigh the expected harms and costs of screening on a population level.”
Experts concur that the benefits and risks of indulging in proactive health screening is like dipping one's hand inside a mixed bag. "When you do tests without any prescription just for timepass and for assuaging your anxiety, you pick up a lot of junk," says Dr Pinto.
