Women, gender and medical screening

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Should you take that medical test that your doctor — or that ad — is telling you to take?

Medical screening tests are increasingly promoted as something that will save or add years to our lives, or at least tell us that we are sick and need treatment. Depression screening, Pap tests, cholesterol screening, and other tests are proliferating as fast as the proposed treatments – often drugs – are being developed. Seldom can we open a magazine, turn on the TV or browse the Internet now without being asked to take a test – or to request one from our doctors.

Screening is an important issue for women because women use the health care system more than men and thus are also likely to be screened more often than men. We are also more likely to self-screen (using tests in magazines, on the web, in books, etc.). It’s important to think about the issue of screening using a gender lens.  There are tests that are unique to women for conditions only women have, such as Pap tests for cervical cancer and screening for post-partum depression. Screening for women and men might also be different for the same disease, such as with colon cancer (women tend to get colon cancer at older ages than men).

Why shouldn’t you take that test?

Questioning the value of screening might appear strange. After all, isn’t it good to have more information about your health? There is no doubt that screening has an important place in health care, and usually it is good to have more information about your health, but there is increasing evidence that not all screening is good for your health. Screening has clear benefits in many cases, but it also carries risks. It is very important, when we are being offered tests at every turn, to understand not just the risks of the test itself (e.g. the risks of radiation from a CT scan) but also the risks associated with “downstream” effects of the test. Screening can lead to over-diagnosis and to over-treatment such as unnecessary drug treatment or surgery. If the test tells you that something might be wrong, what further tests or treatments will you be offered or told that you need? Will the effects of the treatment be worse than the disease? And how accurate is that test at diagnosing the disease?

Who profits from the tests?

Also important to consider is that pharmaceutical and medical screening industries stand to profit greatly from making us think we need more tests.  These companies reach us not only through advertising or free samples at doctor’s offices. Medical correspondents on TV offering advice and celebrities telling their illness stories – often sponsored by the drug industry – are also making us think we’re not getting enough tests.

There is a grave danger that this push for screening is making healthy people think they are sick – giving us ‘new’ diseases to treat, such as ‘female sexual dysfunction’ and ‘compulsive buying disorder’? When over-simplified screening tools for depression or other mental illness can be easily accessed through social media like Facebook, and suddenly everyone is diagnosing themselves as severely depressed, this gives drug companies the ammunition to say occurrence rates are very high, adding, “Here, we have a drug for that.”

For more information on how unnecessary pharmaceuticals are often over-promoted to women, see our primer Prescription drugs for women: How safe? How effective? How necessary? The book Push to Prescribe is another excellent resource devoted to this topic.

Looking critically at some of the tests

With an abundance of screening tools now in use, we have selected just a few to consider here. While mammography is a hotly-debated major screening tool, we have examined that issue in detail in Mammography screening: Weighing the pros and cons for women’s health by Ann Silversides so we have not included it here. This primer looks critically – with a view that you may not find in the mainstream media – at some of the other screening tests that are particularly relevant for women.  Each test we have chosen here is the subject of some current debate about its usefulness and/or about the dangers of overscreening. We look at:

What are the problems with too much screening?
Why not take that bone-density test?
Shouldn’t you find out if you’re suffering from depression?
What are the debates about genetic screening?
What could be the matter with screening for heart disease?

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