Episode 12: To Test or Not To Test?

Live Long and Well with Dr. Bobby

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We’re bombarded with advertisements for all sorts of tests these days: comprehensive blood panels for a few hundred dollars, total body MRI scans for cancer detection, heart calcium scans, and even tests to rule out multiple cancers. But are these tests worth it if you are asymptomatic and don’t have an important family history?

A few years ago, I experienced fainting episodes while running. After a series of tests, including seeing a cardiologist, I was told that my blood pressure dropped upon standing—a condition that required no treatment, just caution. During these tests, they found that my heart was larger than usual. This discovery led to a lot of anxiety over the years, despite it likely being a false positive. This case illustrates how even with legitimate symptoms, testing can sometimes lead to more questions than answers. And, large panels of tests compound the problem.

The Issues with Testing

It’s tempting to think that more testing is better, but the reality is that tests are imperfect. They’re often based on statistical averages, and results can be misleading. For example, if you undergo multiple tests, you’re likely to get some abnormal results just by chance. This can lead to further testing, expense, time, potential medical complications, and unnecessary worry.

Medical Expert Recommendations

Organizations like the US Preventive Services Task Force and the American College of Radiology provide guidance on screening tests. They recommend specific tests like pap smears, mammograms, and colonoscopies, but not routine total body MRIs or large blood panels. Even well-regarded screening tests can result in false positives, as shown by studies and practices in countries like South Korea.

Real-Life Examples

I’ve seen friends go through the stress of false positives from MRIs or calcium scores, leading to further tests and anxiety. It’s essential to weigh the potential impact of these findings on your life, including how they might affect insurance and your mental well-being.

Conclusion

To sum up, while early detection of health issues sounds appealing, the reality is that many screening tests can lead to false positives and unnecessary complications. If you’re asymptomatic and don’t have a concerning family history, it’s often best to save your money and avoid these tests. Always consult with your doctor to make informed decisions based on your specific health needs.

Chapters

1. Episode 12: To Test or Not To Test? (00:00:00)

2. Introduction (00:00:48)

3. Take-home messages (00:02:22)

4. Case study (00:05:01)

5. The Limitations of medical testing (00:08:27)

6. What do the experts say? (00:18:59)

7. How screening found cancer but did not affect mortality (00:23:51)