Importance of disease screening

The greatest value of disease screening has never been to “detect diseases”, but to bring the initiative of health from the emergency room back to the daily lives of ordinary people, which can intercept more than 80% of serious diseases in the early stages with the highest cure rate and lowest cost; even if there is the current controversy about “over-screening”, for the vast majority of ordinary people, the benefits of standardized targeted screening are still far higher than the potential risks.

I have been working in a community public health post for almost 8 years, and I have seen too many examples of people who can pat their thighs and say, "Fortunately they were checked." Last summer, the community organized two cancer screenings. Aunt Zhang, who lives in Building 3, refused to come at first, saying that her waist and back were not sore from dancing in the square every day. "It's a waste of money to check if you don't have any disease." In the end, her daughter forced her to fill out the form. The result came out positive for HPV16, and further biopsy showed CIN2 cervical precancerous lesions. It cost less than 4,000 yuan to do a cervical conization and the problem was solved. Now I have regular check-ups and nothing has happened. She later told us that there was a neighbor downstairs who was the same age as her. At the end of last year, she went for a check-up because of vaginal bleeding. It was directly diagnosed as late-stage cervical cancer. She spent more than 200,000 yuan and still couldn't save her life. Now she is scared to think about it.

We in public health often say, "One minute of early screening can save half a year of hospital visits." This is really not a lie. According to data released by the National Cancer Center last year, the overall 5-year survival rate of lung cancer in my country is only 19.7%. However, if stage I lung cancer is detected and intervened promptly, the 5-year survival rate can reach more than 92%. The difference of more than 70 percentage points is simply due to the lack of early screening. This is similar to the regular maintenance of your car. You can't wait until the engine explodes before you think of changing the oil, right? Many chronic diseases and cancers do not feel any pain at all in their early stages. By the time you realize something is wrong, you have often paid several times or even dozens of times the price, and the suffering is incalculable.

Of course, not all screenings are worth doing. There has been controversy over "over-screening" in recent years. I will tell you the truth on this point. There are currently two factions of opinions on the Internet: one is a supporter of evidence-based medicine, saying that there is no need for ordinary healthy people to undergo expensive screening programs, such as PET-CT every year. Not only does it cost tens of thousands of dollars, but the radiation dose is also high, and it may increase the risk of cancer, like the USPSTF (United States Preventive Services Task Force) ) lists only 13 items that must be screened for ordinary adults, and most of the extra items are the IQ tax from physical examination institutions; the other group is a front-line clinical doctor, saying that the recommendations in many guidelines are only the minimum standards. For people with high-risk factors such as family history, long-term smoking and drinking, and staying up late all year round, appropriate additions can really save lives. I met a 42-year-old programmer last year. His father died of intestinal cancer. He started having colonoscopy every three years when he was 35 years old. This year, it was found that a polyp had a tendency to become malignant. He was discharged from the hospital the same day after the operation. If he had started colonoscopy at the age of 45 according to the general guidelines, it might have turned into invasive cancer.

To be honest, both groups are right. The core is actually the word "adaptation". I have seen many people follow the trend and buy a luxury physical examination package worth tens of thousands of yuan. When a small lung nodule was found, they were so scared that they could not sleep all night. They traveled to hospitals across the country for consultation, but they developed anxiety attacks. I have also seen many young people relying on their good health to refuse to even go to the free annual physical examination at their workplace. Last year, there was a 29-year-old I am an Internet operator at the age of 10. My physical examination showed positive for Helicobacter pylori. I didn’t take it seriously at first, but I persuaded me to have a gastroscopy. I found that there were signs of mild atrophic gastritis, so I quickly sterilized and treated him for half a year. Now that I have checked again, nothing has happened. I also took the initiative to get all my colleagues in the department to be tested for Helicobacter pylori.

In fact, to put it bluntly, screening is never meant to keep everyone safe, but to provide an early warning doorbell for everyone’s health. You don’t need to pursue more expensive and more comprehensive projects, just choose the corresponding projects according to your age, family history, and living habits: for ordinary people, it is basically enough to do a physical examination of blood and urine, liver and kidney function, chest X-ray, and abdominal B-ultrasound every year. Those with a family history of bowel cancer should go to 4 Colonoscopy at the age of 0, low-dose spiral CT every year for long-term smokers, and breast ultrasound + mammography every year for those with a family history of breast cancer. It doesn’t cost much, and it can really help you block most of the risks. It can be a reliable purchase even if it’s not a big deal, and it won’t be a loss no matter what.