disease screening census

Targeted screening that matches an individual’s age, gender, past medical history, and family genetic history is currently the health intervention with the highest input-output ratio； However, an “all-project census” that does not distinguish between groups of people may bring unnecessary burdens of over-diagnosis and over-medical treatment.

Last year, I went to the physical examination center with my elderly family member. When the sales started, I was given a "full body cancer screening package" priced at RMB 12,000. Even PET-CT was included in the regular items. It was said that "a single scan of the entire body will reveal all cancer cells." The elderly man was tempted to take out his wallet on the spot. I quickly stopped to ask an acquaintance who was a general practitioner and found out that the old man had no family history of cancer, nor was he a high-risk factor for long-term smoking or exposure to carcinogens. Annual low-dose chest CT and gastrointestinal endoscopy, as well as basic blood tests, were enough. The radiation dose of PET-CT was equivalent to 20 consecutive chest

But what is interesting is that there have always been subtle differences in the views of the public health field and the clinical frontline regarding the value of screening.

Friends who work in public health pay more attention to the universal value of the census. Let’s talk about the data in their hands: the two cancer screening data released by the National Health Commission in 2023 have covered a total of 180 million rural women of school age. The detection rate of early cervical cancer in the areas covered by the project is 72% higher than that in areas not covered. The 5-year survival rate of breast cancer has increased by 11 percentage points. There are also free promotion of fecal occult blood screening and cataract screening for the elderly in many areas, which really nip many diseases in their bud. We often say in clinical practice that "early cancer is 90% curable, while late cancer is 90% likely to die." When this calculation is put into public health, the return on every dollar invested is astonishingly high.

But from a clinician’s perspective, we have encountered too many pitfalls of over-screening. A few years ago, when universal thyroid cancer screening became popular, outpatient clinics would encounter young people requesting thyroidectomy with physical examination reports every week. 90% of them were micro-papillary cancers less than 1 cm. In fact, the probability of such tumors not progressing in their lifetime was more than 80%. If they had thyroidectomy, they would have to take thyroid hormone for life, which would reduce the quality of life. Now domestic and foreign guidelines have been adjusted and no longer recommend that ordinary healthy people undergo routine screening for thyroid cancer, just to avoid such unnecessary harm.

To be honest, when I was doing free health clinics in the community, I met too many people who went to extremes.

A girl in her early 30s with no family history had to spend thousands of yuan every year to check a full set of tumor markers. One time, one of the indicators was 0.2 higher than the reference value. She cried at home for half a month and had all the CT and MRI done. In the end, it was discovered that it was a physiological increase caused by staying up late every day to catch up on projects during that period. There was also an uncle in his 50s who refused to have a gastrointestinal endoscopy despite being persuaded several times. He said, "I am in good health and can eat and sleep." By the time he had blood in his stool and went for a checkup, he had advanced colorectal cancer and had no chance of surgery.

In fact, there is really no need to make screening too complicated, and there is no need to follow the trend and buy expensive packages. If you are over 40 years old and smoke all year round, you can just do low-dose chest CT regularly every year. Ordinary chest X-rays cannot detect early lung cancer at all. ； If you have an immediate family member with colorectal cancer, you can have your first gastrointestinal endoscopy at the age of 35, instead of the age of 45 recommended by the guidelines. ； Women over the age of 25 undergo regular TCT+HPV combined screening, which is 100 times more effective than those "gynecological anti-aging packages" that cost thousands. Last year, the community census found that a 52-year-old uncle had positive occult blood in his stool. We called him three times to urge him to undergo a colonoscopy. It was found that he had early-stage cancer, and the cancer was cured by direct endoscopic resection. The total cost was less than 10,000 yuan. If he had to wait until he had symptoms, the cost of chemotherapy alone would have been hundreds of thousands, and he would have suffered.

To put it bluntly, disease screening has never been about "the more projects you do and the more money you spend, the better." It's just like buying shoes. The expensive ones may not necessarily fit your feet, only the ones that suit you are useful. Don't be led away by the "cancer prevention anxiety" of marketing accounts, and don't hold on to the mentality of "I'm not sick, no need to check". If you are really unsure, it is much better to chat with a reliable general practitioner for 10 minutes than to speculate on your own.