Aug 17, 2022
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Many companies worldwide periodically send their employees to health screening programs, thinking these will detect illnesses early and that they are doing them a favor. But in many cases, according to family medicine experts in Jerusalem, such programs are not a good idea.

Traditionally, the task of health promotion and early detection screening has been the job of health maintenance organizations (HMOs) via the family doctor. For some years, it has been popular for private health organizations to offer a concentrated day of comprehensive medical testing that is promoted as a perk for highly valued employees. But are these health checks based on medical evidence that they are good for patients?

Prof. Amnon Lahad and Dr. Adi Isaacson of the Hebrew University’s Faculty of Medicine and Clalit Health Services – Israel’s largest HMO –warn about the dangers of inappropriate screening provided by such private programs. They published their article in the latest issue of IMAJ – the Israel Medical Association Journal. 

They reviewed official Internet sites of the most popular concentrated days of comprehensive medical testing and compared the tests offered with the recommendations of several Israeli and international guidelines. 

“Every medication, treatment and test we offer to our patients has both benefits and disadvantages that may be known, suspected or potentiated,” they wrote. “Both the advantages and the disadvantages need to be considered for every medical intervention.”

Unlike diagnostic tests that are intended to find the cause of a patient’s symptoms, screening tests are deliberately conducted on healthy people who have no symptoms of a disease that are meant to be found at an early stage, thus preventing it from getting worse. 

But the Israeli experts wrote that tens of thousands of people have to be tested to detect just one abnormality, and such tests are justified only if early detection and thus early treatment has been shown to have a better outcome than if the disease was identified and treated when symptoms appear. 

This is a dilemma, and many countries have a national task force to assess the pros and cons of health screening in people with low risk and no symptoms, based on evidence-based medicine (EBM). 

The Choosing Wisely organization was established a decade ago in the US to suggest ways to avoid unnecessary medical tests and treatments and help patients and doctors to understand the risks of certain interventions. This voluntary group soon became recognized around the world, and national branches were set up in many countries including Israel, where it was financed by the Israel Medical Organization. 

But in this country, as in many others, HMOs and hospitals have begun to offer such screening programs. Among the tests have been chest x-rays for smokers, even though experts in the field announced over 20 years ago that there was no health benefit to annual chest x-rays to detect lung cancer among smokers, which were found to raise death rates from lung cancer y 11% compared with less-frequent x-rays of the lungs. Instead, Lahad and Isaacson declared that smokers should be encouraged to quit smoking to increase their chances of survival. 

Mammography scans are offered in many countries to women from the age of 40 on the basis of theory that “the earlier the better.” But in Israel, it is established policy to start getting a mammogram every two years from age 50 if the woman has no family or personal history of breast cancer. Because younger women have more fat in their breasts, such x-rays often produce false-positive results, overdiagnosis and even surgery. 

A colonoscopy – used to look for changes such as swollen, irritated tissues, polyps or cancer — in the large intestine and rectum using a colonoscopy, a long, flexible tube inserted into the rectum is offered as a screening test no matter what the result of an occult (hidden) blood test every five to 10 years starting from the age of 50. The recommendation for people in whom no blood in the stool was found is offered by some screening programs every five or 10 years. But such a procedure can cause perforation of the colon and massive bleeding in one out of 2,500 patients who undergo this. The patient’s best interests must be considered before he or she is automatically sent for screening at a young age. 

Many men are sent for PSA (prostate-specific antigen) test from the age of 40 to detect prostate cancer, but positive results are often fo9und in men over 50 and in the vast majority of cases, the tumor is self-contained and has no effect on lifespan, the authors write. So many men ensure this complicated and potentially dangerous procedure for a disease that would probably have no effect on the normal course of their lives. 

The Israeli experts recommend making screening days real investments in future health and prevention by encouraging one-on-one conversations between doctors and patients about exercising, actively supporting smoking cessation and discussing appropriate diets to lower risk of colorectal cancer instead of automatically offering colonoscopies in people without symptoms or indications.