It's possible to hurt a patient with a lab test. It's an innocent enough thing to order, but the downstream effects may not be useful at all. The test is done, it leads to an inconclusive result, further testing is done, maybe a referral, and eventually a treatment occurs that shouldn't have happened in the first place. Maybe there is a complication.
PSA testing may be an example. We know prostate cancer is overdiagnosed, such that many men are diagnosed who never would have suffered or died of the disease if nothing was done.
As part of the Choosing Wisely campaign, professional societies recommend caution with PSA tests:
- The American College of Preventive Medicine says, "Don’t routinely perform PSA-based screening for prostate cancer." 1,000 men need to be screened to save one life, and false positives and suffering are much more likely for any individual than being saved by the test. Obviously, your threshold for testing should be adjusted for risk factors like family history.
- The American Academy of Family Physicians generally agrees, but notes that "whether [the] potentially small benefit in mortality outweighs the potential harms is dependent on the values and preferences of individual men," so shared decision-making should be used.
- The American Society of Clinical Oncology says that there is no mortality benefit of PSA screening, so especially with men expected to live less than 10 years, don't screen.
There are some great resources for shared decision-making on the web and in book form. See, for example, the book Cancer Screening Decisions.
The Choosing Wisely campaign encourages specialty societies to identify tests and treatments of questionable value - things that should cause us to pause and think.
"Have a conversation, not a test."
Source: Cancer Research UK / Wikimedia Commons