October 30, 2009 | 7:41 pm

Proactive or Paranoid?  When Vigilance is Valueless

Posted by Albert Fuchs, M.D.

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What a better topic for Halloween than fear?

All of us when hearing of a coworker or loved one who has been diagnosed with a life-threatening illness wonder if we could be next.  “What if I have lung cancer?  Should I get checked out?  There must be some tests I can get to make sure I’m OK.”  Those who take an active role in staying healthy are confident that they could do more to make sure they don’t get some dreaded disease.  Most cancers, after all, are preventable, right?  Or at least they can be caught early?

The scary truth is that most cancers are not preventable and can not be caught early by any test we currently have.  What’s even worse, for many cancers there is no evidence that an earlier diagnosis makes any difference in outcome.

That doesn’t mean that no prevention is effective.  For a few cancers (breast, cervical, colon) there are proven tests that are recommended periodically for everyone.  That’s why I’m an enthusiastic advocate for colonoscopies for people over 50.  Also, testing blood pressure and cholesterol in healthy people helps prevent strokes and heart attacks.

So how can we know what we should be doing to stay healthy?  Should I get a head-to-toe CT scan?  What about that “executive physical” with the fancy heart tests that my neighbor says I should have?

This is the job of the U.S. Preventive Services Task Force.  They are the most unbiased national group that evaluates the evidence for preventive tests and treatments.  Check out the links below to see what you should be doing to prevent what’s preventable.  Just as important is learning what tests are unproven (or proven to be worthless).  The second link, the Electronic Preventive Services Selector is especially handy.  You enter some simple data about yourself and it displays all the proven preventive services for you.

That’s how you can have the confidence of knowing that you’re doing everything you can.  Having tests that have been proven to be useless isn’t being proactive; it’s making an irrational decision based on fear.

There are plenty of terrible diseases out there that outmatch our best tests and treatments.  But after a moment of reflection, this is not a reason to panic.  It’s a reason to do what is sensible to stay healthy and then to focus on your life, not your health.  The rational fear is not “What if I have pancreatic cancer?” but rather “What if I’m healthy and spend the next decade worrying about pancreatic cancer?”

Have a happy and calm Halloween.  And face the future unafraid.

Learn more:

U.S. Preventive Services Task Force recommendations

Electronic Preventive Services Selector

Important legal mumbo jumbo:
Anything you read on the web should be used to supplement, not replace, your doctor’s advice.  Anything that I write is no exception.  I’m a doctor, but I’m not your doctor despite the fact that you read or comment on my posts.  Leaving a comment on a post is a wonderful way to enter into a discussion with other readers, but I will not respond to comments (just because of time constraints).