Should You Get a Mammogram or Prostate Test?
Should you be tested or take your chances?
Posted October 12, 2011
With breasts and prostates being such key body parts, and with cancer being the most-feared disease, there has been lots of attention to news about changed recommendations for medical testing. Most notably, the United States Preventive Services Task Force said that healthy men generally should not be screened for prostate cancer with the P.S.A. (prostate-specific antigen) blood test. Similar issues and controversies arise concerning the need for early and frequent mammograms to look for the first signs of breast cancer.
Wouldn't it be nice if you could help evaluate these matters in terms of your own individual risks and lifestyle? Although the definitive studies have not yet been done, there are some ways to proceed that make a lot of sense.
The basic dilemma --to test or not to test-- arises because there are both risks and benefits from every medical test. One problem with getting tested is that the tests are not that accurate and you may well receive a warning in error; this is the so-called "false-positive." That error in turn leads to further testing, including unneeded biopsies, which are expensive procedures in which a needle or scalpel is used to cut out a small piece of your bodily tissue for examination by a pathologist. Even if you do not mind the cost, the pain, and the worry of going through this, you may be annoyed to know that even the biopsy results have considerable uncertainly associated with them and what to do next.
The bigger problem (to my mind) is that if the test reliably indicates the presence of cancer cells, you will almost certainly have a surgical operation, or radiation, or chemotherapy, or all three. These miserable treatments can significantly prolong life if you have a life-threatening cancer. But --here's the rub-- many early-developing cancer cells never grow into full-blown cancer. Many adults have some cancer cells in their bodies but never develop cancer. And, for many (but not all) cancers, very early detection does not guarantee a better outcome.
The psychology of the matter is so important because we tend to make poor decisions when we are fearful and when we overlook information about the overall risk. So if you are basically healthy, the first thing to do (before getting any tests) is to calmly look over the risk statistics and then ask your primary care doctor (that is, your family practitioner or your internist) whether a particular screening is really, really necessary in your case. Often you will hear that it is no problem to wait another year or two or more. But I have a further suggestion.
If you are on a healthy pathway in life, you are much less likely to develop disease or die before your time. In our eight-decade study of paths to health and long life, The Longevity Project, we discovered a whole host of things you can do over the years to maximize your chances staying very healthy. If you are on a very healthy pathway, your chances of cancer drop dramatically! Ironically, the medical screening tests then become even less accurate (and so less valuable). Sounds simple when said this way, but too many people obsess over medical tests when simpler, cheaper, positive steps to long life are right before their eyes.
When it comes to longevity, there are no money back guarantees. Some people with a healthy, prudent lifestyle will suddenly face tragic disease, just as some unlucky individuals will be run over by drunken drivers. In those cases, a skilled physician can be a wonderful help. But for most of us, there are lots of things we can do to protect our health that do not involve any risk or medical expense at all. An extra bonus is that increases in your overall health decrease your need for many problematic and invasive tests.
For more information on The Longevity Project see http://www.howardsfriedman.com/longevityproject/
There are self-assessment scales to help plot your own health trajectory.
There is also a Facebook page for discussion of The Longevity Project.