Pandora's box of tests you don't need

What if something were wrong with you and you didn’t know it? That would be unfortunate. But what if nothing were wrong with you and then a screening test performed in a local parking lot “suggested” that perhaps something might be wrong. What if you have more tests and those tests cause problems, but you find out you were OK in the first place? What if, while trying to find out whether you’re among the lucky majority who are just fine, you end up with surgery you didn’t need and get a surgery complication that threatens your life?

Screening tests are designed to find hidden problems. Some screening tests make very good sense, can find problems early, and make a difference in your health. Good screening tests should help you know your numbers to manage your health — blood pressure, cholesterol, blood sugar and Body Mass Index (based on height and weight: nhlbisupport.com/bmi). These tests identify problems you are more likely to have, such as hypertension, high cholesterol, diabetes or a weight problem. Other screening tests, such as mammograms and colonoscopies, can find cancers in early, treatable stages. Find out what tests you need at healthfinder.gov

Some tests are very sensitive and identify most people with the problem. Some are so sensitive that they find a potential problem, even if none exists. A potential problem found on a screening test usually requires further testing. That’s where the risk comes in. Tests, biopsies, medications and surgery carry some risk. Some are riskier than others. Some give you unnecessary radiation. Others can lead to complications including heart damage, infections and other unfortunate problems. Most of the time, all goes smoothly, but if your risk of complications from the additional testing after the screening test exceed the risks of the problem you were originally screening for, your luck is better without the screening test. If you get complications from the follow-up tests stemming from a screening test for a problem you probably didn’t have, you just created more problems.

Balancing the benefits and the risks of screening tests is complex. The U.S. Preventive Services Task Force (USPSTF) analyzes the evidence and grades each test, procedure or intervention on its usefulness and risk/benefit balance. The USPSTF identifies which screening tests have a good chance of helping you and which ones may be a bad idea and are unnecessary.

One example of harm outweighing benefits of a seemingly benign test is the carotid artery screening, which tests for the risk of stroke with an ultrasound of the arteries in your neck. The USPSTF recommends the average person not have the test because “harms outweigh benefits.” In the general population, the test would err in showing more people have the problem when they don’t, leading to surgeries or other procedures with risks of harm.

So before you open the Pandora’s box of advertised tests to find out if you are OK, check out test tests at uspstf.org and healthfinder.gov and talk with your nurse practitioner or physician.

Maitland resident Nancy Rudner Lugo is a nurse practitioner and president of Health Action, offering workplace health consulting and nurse coaching. Visit www.healthaction.biz