The main thing to realize is that there is no one right way to answer the question of whether to be tested. Two doctors who have devoted most of their careers to medical decision making one of whom also served as editor-in-chief of the New England Journal of Medicine for almost a decade have referred to the close calls in screening as "toss-ups": "situations in which the consequences of different decisions are, on average, virtually identical."
They go on to argue that under these circumstances it is impossible to create a bad decision about how to proceed next. But they are also quick to add that it is important for doctors to identify clearly those situations that qualify as toss-ups so that patients can focus on more personal considerations.
These doctors are referring to what are arguably the most widely recognized close calls in screening: mammography for women in their 40s and PSAtesting. But the notion of a toss-up applies to screening decisions in general. And in every close call, your personal considerations matter. On one side, you have the potential benefit of screening: a lower risk of death. But as you saw in the last article, this benefit is so rare that it is exceedingly difficult to determine whether it in fact exists much less measure it.
On the other side are the potential harms the subject of most of this book. They are more common than the benefits, but for the most part of less consequence. Or let me be more specific: the harms with arguably the least consequence cancer scares and additional testing are quite common, while those with the greatest consequence complications and/or death from unnecessary treatment are very uncommon.
For most of us, however, the most likely outcome of cancer testing is nothing: neither benefit nor harm. So unless you seek out every cancer test ever developed and undergo them frequently (an approach where the risks are really too high), it is hard to go too wrong. But it's still important to take into account the decision, because not every choice will necessarily be best for you.
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08152010
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