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Values of health checks, breast screening, flu vaccine questioned

The BMJ of 24 November 2012 has a Cochrane systematic review and metanalysis that questions the value of routine health checks. Not only do they fail to prevent death or illness, they may also cause harm through unnecessary investigations or treatment.

We did find that health checks led to more diagnoses and more medical treatment for hypertension, as expected, but, as these did not improve mortality or morbidity, they may be considered harms rather than benefits.

The same issue of the BMJ also has a piece about screening for breast cancer. It reports an article in The New England Journal of Medicine which finds that screening has led to the overdiagnosis of breast cancer in 1.5 million women in the USA in the last 39 years. Mammography only marginally reduced the rate at which women presented with advanced cancer. Although death from breast cancer has reduced considerably over this period, the reduction is mainly due to better treatment, not screening.

Here are a couple of quotes from the article in the NEJM.

Our study raises serious questions about the value of screening mammography. It clarifies that the benefit of mortality reduction is probably smaller. and the harm of overdiagnosis probably larger, than has been previously recognized.

Although no one can say with any certainty which women have cancers that are overdiagnosed, there is certainty about what happens to them: they undergo surgery, radiation therapy, hormonal therapy for 5 years or more, chemotherapy, or (usually) a combination of these treatments for abnormalities that otherwise would not have caused illness.

Finally, there is an article citing a report from the University of Minnesota which says that the effectiveness of 'flu vaccination has been greatly overestimated, at least for the over-65s for whom it is mainly recommended. There is no harm in having the vaccine, but it should certainly not be made compulsory fo health workers, as is increasingly happening.


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