The significance of disease screening

The core significance of disease screening, to put it bluntly, is to replace the passive logic of "waiting for the disease to come to your door before treating it" with the pre-emptive prevention and control of "actively identifying early risks" - using the lowest economic and physical costs to intercept the disease in its bud or even before it develops, and at the same time help healthy people eliminate unnecessary health anxiety.

When I was helping with two-cancer screening education at the community health service center last year, I met Aunt Zhang Guiying, 52, who lives in the neighborhood next door. She usually dances square dances, takes care of her grandchildren, and rarely catches a cold. If the community staff had not called her three times, she would not have come to join in the "free examination fun." The results showed that HPV16 was positive, and further biopsy revealed that it was a CIN grade 2 precancerous lesion. I spent less than 3,000 yuan to undergo a minor surgery with a sharp knife. Now I have a reexamination every six months, and it is completely the same as normal people. If you think about it, if she didn't do this screening and went to the hospital after contact bleeding occurred in two or three years, the high probability would be invasive cervical cancer. A uterus removal, radiotherapy and chemotherapy would be indispensable. The treatment cost hundreds of thousands, and she would have to peel off the skin.

But to be honest, the controversy about screening has never stopped over the years. There are two completely opposite views around me. Colleagues in the public health system who are engaged in nationwide prevention and control always want to expand the coverage of screening for high-risk cancers such as lung cancer, gastric cancer, and cervical cancer as widely as possible. After all, judging from population data, for every 1,000 more high-risk groups covered, at least 3-5 more early-stage patients can be identified, which can save the happiness of several families. However, Fa Xiao, who works in gastroenterology clinics, always complains about excessive screening: he recently treated a 28-year-old girl who had no family history of lung cancer, no smoking, and no long-term exposure to oil fumes. Because she read too much popular science about lung cancer, she had to do chest CT three times a year for two consecutive years, but she ate a lot of extra radiation. There are also young people who have no family history of bowel cancer and no long-term intestinal discomfort. In fact, there is nothing wrong with these two views. They are just different perspectives: one calculates the health ledger of the whole society, and the other calculates the individual risk-benefit ratio.

I have seen too many people's understanding of screening go to extremes, either "I am in very good health, and it is just a waste of money to get tested", or "I was tested once and it was fine, and I will never need to be tested again in this life." Two years ago, an old neighbor came to me to get a physical examination. He was 48 years old and had a history of smoking for 20 years. His father died of lung cancer. I persuaded him to do a low-dose spiral CT. He waved his hand and said that I had done it when I was 40 years old. Nothing happened and there was no need to spend the money. After waiting for a long time, I just ordered a regular chest X-ray. As a result, I went to the hospital because of a cough with blood during the Chinese New Year. I was found to have late-stage small cell lung cancer. It only took half a year from diagnosis to discharge. If he had listened to the advice and had a CT scan and found it early, the 5-year survival rate would have been over 90%, but it would not have reached this level.

In fact, if you think of screening as an annual physical check-up, you will understand. If you buy a car worth hundreds of thousands of dollars, you have to spend thousands of dollars on maintenance every year. You are afraid that it will break down halfway. How come you feel that a few hundred dollars of screening is a waste of money? If you really wait for the engine to burn out before repairing it, the cost will not be dozens of times higher. And screening also has a hidden effect that many people don’t notice: it helps you eliminate unnecessary health anxiety. I met a young man last month who always felt like he had something growing in his stomach. He couldn't eat or sleep well. He lost more than ten pounds in two months. He had a gastroscopy but nothing happened. He ate three large bowls of rice that day. Do you think this counts as the purpose of screening?

After all, screening has never been more expensive, the more the better, nor can it be done once and for all. If you don’t know what you should do, go to the community health service center near your home and ask. The public health department now provides free risk assessments. They can tell you clearly what your age, underlying diseases, family history, what to check, and how often to check. Don’t wait until you actually have symptoms to worry. By then, it’s often already too late.