Commercial screening tests: Beneficial or a hypnosis to advertisements?S Singhal1, K Deokar1, M Verma2
1 Department of Pulmonary Medicine, All India Institute of Medical Sciences, Rajkot, Gujarat, India
2 Department of Radiation Oncology, KGMU, Lucknow, Uttar Pradesh, India
Correspondence Address: Source of Support: None, Conflict of Interest: None DOI: 10.4103/jpgm.jpgm_300_22
Source of Support: None, Conflict of Interest: None
For the last few years, we have been receiving calls from our relatives and friends to opine on the screening health investigations, which were done either after getting news of a death in the neighborhood or casually after seeing social media or newspaper advertisements. We are regularly getting many people in our outdoor for consultation with anxious looks after seeing the highlighted values of some investigations. Even if reports are normal, they will come to the physician for assurance. They feel that if reports are normal, everything is fine without looking at their food habits, sedentary lifestyle, obesity, and sleep pattern.
Screening is identifying risk factors or diseases in the early stage with the intent to improve the health of individuals. The urine and blood sugar tests to diagnose diabetes mellitus are the first example of modern mass screening since the 1940's. Ideally, the physician should order screening tests according to age or risk factors for asymptomatic individuals. Physician-assisted screening for hypertension, dyslipidemia, diabetes, and tobacco use, along with lifestyle modification and drugs, can prevent more than 50% of heart attacks and strokes.
However, the increasing availability of direct-to-consumer screening tests is undermining cost-effective screening services. The commercial companies now heavily promote “packages” of screening tests at “discounted” prices that anyone can use regardless of risk factors. Most of these tests are done without any valid medical indication. Also, many tests offered in the package do not have the high sensitivity, high negative, and positive predictive value required for a good screening test. Not all tests have evidence of effectiveness. Most of the tests are not a part of the screening pathway, and hence even if an abnormal result is detected, there is no evidence-based intervention that can be offered.
In real life, the chances of detecting a significant disease by routine health checks of asymptomatic individuals are only 0.5–3%. However, heavy promotion, easy access to medical information on the internet, electronic orders with one click, lack of counseling about the potential risk of an abnormal test result, and unawareness that a screening test is not diagnostic are the reasons for their widespread use. Some may argue in favor of general screening that detecting disease will promote healthy behavior in individuals. However, the evidence to explore the relationship between screening and healthy behavior is contradictory. The number of trials studying the impact of screening on healthy behavior appears to be very limited. Only a slight improvement in healthy behavior was observed in these studies, which diminished over time. On the contrary, evidence has shown that screening tests could discourage the healthy behavior of individuals with normal results and may interfere with population strategies designed to promote healthy behavior. It may undermine the role of individual behavior to promote good health and lead to more focus on regular physician visits and screening tests only.
Advanced laboratory techniques result in the early detection of pathophysiological changes, most of which are of no clinical significance and do not require any interventions. However, it may start a chain reaction of referral and additional testing to confirm or refute these abnormal findings. Further investigations, overdiagnosis, inappropriate disease labels, unnecessary overtreatment can cause anxiety and potential other harms.
The screening of asymptomatic persons in the general population with nonindicated tests is neither medically beneficial nor does it promote behavior change. Hence it is not ethical to permit the marketing of screening packages to the public. Commercial screening companies can be allowed once they reveal the recommended indications, benefits, and potential risks and harms from published guidelines. Before introducing a screening test to the general public, a thorough risk-benefit analysis must be done. Today, we have evidence-based screening programs like screening for cervical cancer and lung cancer., Not all individuals are the same; hence besides the type of screening test, it is also vital to evaluate the kind of personality getting the screening test as adherence to lifestyle advice depends on individual nature. Health screening tests based on risk evaluation of the factors by physicians, accompanied by lifestyle advice and medications, must be advocated. People must take responsibility for their health rather than fall prey to these advertisements.
Randomly carried out screening tests are potentially harmful, particularly for those who won't benefit from screening. Evidence-based screening programs have great potential to improve public health outcomes as shown by cervical screening program. However, these randomly performed isolated commercial screening tests that are not part of any screening pathway will incur more harm than benefit. Hence, only the evidence-based screening programs which include a screening pathway must be advocated and promoted to gain maximum benefit and minimize harm.
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