What’s the Harm?
We have to remember that screening matters only if detecting a disease early makes a real difference in terms of outcomes, and if screening leads to a significant decrease in the detection of advanced disease. In practice, screening often doesn’t lead to earlier diagnosis. Additionally, the later development of better treatments for later-stage disease can mitigate the advantages seen from screening in earlier studies.
What screening often does, though, is cause some level of harm. Overdiagnosis and overtreatment can have detrimental consequences. Even the psychological worry from a false-positive result can have real-world implications.
These are screening tests recommended by the USPSTF, and the evidence for them is scant. Many other screening tests done by physicians don’t even have this level of supportive evidence. Further, because of the Affordable Care Act, insurance must pay for all screening tests recommended by the USPSTF with a grade of A or B, regardless of whether they are cost-effective.
In spite of this, many people, including many physicians, still maintain that screening tests and the annual checkups in which they occur have merit. There’s a good chance that they’re right. But at this time, the arguments being offered are not supported by robust evidence.
If other outcomes matter, then they should be put front and center. If what we are doing has merit outside of mortality prevention, an explicit case needs to be made for those gains. Otherwise, we are not only encouraging, but mandating, that our health care dollars be spent in a way that seems unjustifiable to many.