What are the problems with too much screening?

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While overscreening is under more scrutiny lately, we have found little gender analysis in the literature on this issue to date. We do find analyses of how screening is overused in various contexts, the relationship of screening with the pharmaceutical industry, and how overscreening may be leading to unnecessary treatment and to "pathologizing" healthy people.

Seeking Sickness: Medical Screening and the Misguided Hunt for Disease
By Alan Cassels, Greystone Books, 2012
Discusses the most common and recommended types of screening and weighs the pros and cons of each. Deals with questions such as: Do mammograms save lives? Is a colonoscopy necessary for everyone? Is it worth it to spend thousands of dollars for a whole-body scan? Also examines the roles of practitioners and drug companies in getting us to “test-early-and-test-often.”

Over-Diagnosis Epidemic 
By Ray Moynihan, The Conversation, 2012
A ten-part series that outlines the growing problem of over-diagnosis.

Legal Drug-Pushing: How Disease Mongers Keep Us All Doped Up 
By John-Manuel Andriote, The Atlantic, April 2, 2012
Argues that pharmaceutical companies increase consumer demand for more screening and medications by manipulating our fear of suffering and death.

If You Feel O.K., Maybe You Are O.K.
By H. Gilbert Welch, New York Times, February 27, 2012
Maintains that “the fastest way to get heart disease, autism, glaucoma, diabetes, vascular problems, osteoporosis or cancer ... is to be screened for it. In other words, the problem is overdiagnosis and overtreatment.”

‘Get with the Program!’: Pharmaceutical Marketing, Symptom Checklists and Self-Diagnosis
By Mary Ebeling, Social Science and Medicine, July 26, 2011
Reviews and analyzes disease awareness campaigns sponsored by pharmaceutical companies that use self-diagnostic tools. Uses the example of premenstrual dysphoric disorder (PMDD) to discuss how the marketing of self-diagnosis can change the patient into a consumer to achieve the aims of drug companies. (Abstract only is available without subscription.)

What You Should Know About Medical Screening
By Alan Cassels, The Tyee, June 20, 2011
A series of articles examining the issues of unnecessary medical screening. Argues that pharmaceutical companies are driving the increased push for screening. 

Uninformed Compliance or Informed Choice? A Needed Shift in Our Approach to Cancer Screening
By Michael Edward Stefanek, Journal of the National Cancer Institute, 2011
Argues for more efforts to educate screening candidates about the harms and benefits of cancer screening in general, and to engage in shared (doctor and patient) decision making about taking the tests. (Abstract only is available without subscription.)

Sex, Lies & Pharmaceuticals: How Drug Companies Plan to Profit from “Female Sexual Dysfunction” (Webinar)
Canadian Women’s Health Network, 2010
Drug assessment specialist Dr. Barbara Mintzes looks at the ways women’s sexual difficulties are being repackaged as symptoms of a disorder called “female sexual dysfunction” in order to feed a marketing machine that promises to “cure” it. Dr. Mintzes and Ray Moynihan co-authored the book, Sex, Lies, And Pharmaceuticals.

A Leading Health Policy Issue for 2010-11: Communicating Tradeoffs in Screening Test Decisions
Health News Review, 2010
Looks at how news reporting on health issues, coupled with the influence of the drug and medical testing industry, has contributed to what the author calls “screening madness”.

Myth: Whole-Body Screening is an Effective Way to Detect Hidden Cancers
Canadian Health Services Research Organization, 2009
Discusses how whole body screening (e.g. Computerized Tomography (CT) scans, Magnetic Resonance Imaging (MRI) technology or Positron Emission Tomography (PET) scans) is promoted to healthy people as preventative health care, while the evidence shows it offers no proven health benefits and exposes people to unnecessary health risks.

What’s in a Scan? How Well are Consumers Informed About the Benefits and Harms Related to Screening Technology (CT and PET Scans) in Canada?
By Alan Cassels, Jaclyn van Wiltenburg and Wendy Armstrong, Canadian Centre for Policy Alternatives, 2009
Argues that private clinics selling high-tech services to screen healthy people for disease could be harming Canadians and placing an undue burden on the public health system.

Literature Review on Effective Sex- and Gender-Based Systems/Models of Care
By Christine Brittle and Chloe E. Bird, U.S. Office on Women’s Health, 2007
Examines the literature on screening differences between women and men. For example, women are more likely to “self-screen” and to spend more time being screened. Also examines how women in different ethnic groups are screened differently because of issues such as lack of health insurance, lack of transportation, and not having a family doctor.

Myth: Early Detection is Good for Everyone
Canadian Health Services Research Organization, 2006
Looks at how many widely used screening tests are not very accurate, or find conditions for which there is no effective treatment, or, at their worst, leave patients worse off than they were before.

Screening: AFMC Primer on Population Health - A Virtual Textbook on Public Health Concepts for Clinicians
Chapter 9, Part 3 - Practice: Improving Health, Association of Faculties of Medicine of Canada
A primer for medical students that looks at the pros and cons of screening, examining the ethical issues of overscreening and who profits from promoting the tests.

Private Health Screening: What to Think about When You’re Thinking about Screening Tests
The website of a group of doctors in Britain concerned about the safety and the ethics of private screening tests, and about companies who advertise those tests. Includes resources to help people decide whether or not to take a screening test.

Choosing Wisely
An American campaign to encourage physicians, patients and other health care stakeholders to think and talk about medical tests and procedures that may be unnecessary, and that in some instances can cause harm.

NEXT:
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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Women, gender and medical screening