Screening tests and invasive biopsies « Punk Rock Operations Research

screening tests and invasive medical procedures « Punk Rock Operations Research.

A nice blog post by Laura McLay on a few of the paradoxes of cancer screening, and the human reactions to it. Everyone should read this weekend’s NYT article on breast cancer screening, by Peggy Orenstein. Title is Our Feel-Good War on Breast Cancer.  One of my reactions to Peggy Orenstein being the author: age really does bring wisdom!

My extended family went through a scare caused by over-testing a few years ago. Nobody was at fault, but different family members have very different responses to uncertainty.

Here is the abstract to the article Laura mentions on prostate screening.

Debate regarding the prostate-specific antigen (PSA) screening test centers around test reliability and whether screening reduces mortality.1– 3 We consider yet another potential downside to the widespread use of unreliable screening tests: the downstream effect of receiving inconclusive or ambiguous results. When receiving information from screening tests, we usually want to know whether the result is a “yes” or a “no.” Receiving an inconclusive result amounts to a “don’t know”; this situation should have a level of uncertainty regarding the diagnosis similar to that of not conducting the test at all. Yet, we propose that the psychological uncertainty experienced after an inconclusive test result can lead to investigation momentum: additional, and potentially excessive, diagnostic testing. In contrast, not conducting the unreliable test would result in no further action. To investigate this, we evaluated whether receiving an inconclusive result from an unreliable test (the PSA screening), compared with undergoing no test, motivated more individuals to undertake an additional, more invasive and costly, test (a prostate biopsy).

 

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