I couldn’t help but raise an eyebrow when Bryan Johnson, a tech entrepreneur and longevity advocate, shared his girlfriend’s “vaginal microbiome report” back in April. Apparently, it ranked in the “top 1%,” which, I mean, it’s intriguing, but most healthcare professionals don’t actually recommend this sort of testing on a regular basis.
As advancements in medical technology continue to grow – and become more sellable – the division between beneficial screenings and unnecessary tests becomes more scrambled. Sure, some tests are crucial for catching diseases early and preventing premature death. But the direct-to-consumer testing sector often hypes up tests that, while aiming to provide reassurance, frequently yield unclear results. This can lead to costly follow-ups or simply leave people worried about hidden health threats.
So, let’s dive into what you should know about screening tests.
What is medical screening?
Medical screening refers to tests that look for potential health conditions before symptoms arise. The best screening tests identify treatable issues before they escalate and allow clinicians to intervene, potentially preventing severe health consequences. Importantly, effective screening tests shouldn’t cause harm, whether that’s financial strain or introducing new issues.
For example, blood sugar tests and blood pressure checks are solid screening options. They can uncover conditions like diabetes and high blood pressure, which can silently wreak havoc on your body for years. If caught early, interventions can stop these conditions from progressing. Otherwise, they can significantly shorten lives, leading to complications like blindness and heart attacks.
These screenings are not only affordable but also straightforward. Plus, preventative measures such as dietary changes or established medications tend to do more good than harm.
Is more screening better?
It’s tempting to think that having more information about your body equals more power. But that’s not exactly true. “Overscreening” is a term used to describe excessive testing that uncovers findings which may be untreatable or unnecessary, triggering a cycle of further tests and questions that can be costly and risky.
It can be tricky to accept that sometimes, more tests can lead to more confusion. Take, for instance, full-body MRI scans. They’ve gained popularity among tech enthusiasts and some celebrities, marketed as a proactive way for healthy individuals to detect diseases early. However, while this technology can reveal abnormal anatomical structures, it often can’t discern their relevance, leading to many discoveries of “incidentalomas” – tiny, insignificant findings that might cause unnecessary alarm. In one review, an astonishing 95% of scan participants had abnormal results, with only a minuscule number being potentially cancerous.
Gilbert Welch, a researcher at Brigham and Women’s Hospital, notes that humans often have various abnormalities, especially as they age. But since doctors can’t determine which findings are significant, they often pursue all leads.
What are the harms of overscreening?
Technically, incidentalomas aren’t likely to cause harm directly, but they can lead to an unnecessary series of tests and procedures that consume time and resources, potentially resulting in discomfort or complications.
Even standard tests can be misapplied too frequently. There’s been ongoing debate over the ideal frequency of mammograms for breast cancer detection, especially among low-risk populations. While more frequent screenings typically catch more early-stage cancers, they don’t always translate to significant reductions in advanced cases or overall mortality. And, a lot of what they detect might never become harmful. In fact, for older women, increased screening can sometimes result in unnecessary invasive procedures.
Overscreening can also heighten anxiety and create a sense of ill health. As neurologist Suzanne O’Sullivan points out, someone might head into a screening feeling great, but uncertain results can shift that perspective completely.
For routine screenings, it’s worth noting that those with certain family histories are often advised to begin testing earlier or get screened more frequently. For instance, people with immediate family members who had colorectal cancer might be encouraged to schedule colonoscopies sooner.
O’Sullivan believes that complex screenings could be more beneficial if we had a better grasp of disease progression. In the meantime, “there’s a lot of profit being made off the illusion of health,” she states.
What should you do before signing up for the latest trending screening test?
Most primary care providers have a good handle on which tests are suitable for you at various life stages. They typically base their recommendations on evidence-backed guidelines and can help you decide if a direct-to-consumer test is worthwhile.
Keep in mind that the FDA doesn’t review all DTC tests, and it may be tough to find independent assessments of their accuracy. If you’re considering a test, it’s useful to ask questions like: does this actually reduce risk or just raise awareness? How often does it yield false positives? And is the response to potential findings safer than doing nothing at all?
Ultimately, Welch emphasizes that true health comes from simple, age-old advice: eat well, get active, and form meaningful relationships. He noted that while we’re teaching the newer generations that tracking data on oneself is the route to health, “you can’t test yourself into good health.”
