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Yahoo! My Yahoo! Mail More Yahoo! Services Account Options New User? Sign Up Sign In Help Yahoo! Search web search Home Singapore Asia Pacific World Business Entertainment Sports Technology Asia Pacific World False-Alarm Medical Tests By Baldwin William - Friday, June 25 Send IM Story Print False-Alarm Medical Tests It's the call that everyone dreads and lots of people get: The doctor needs to have you come in for more tests. "There was an abnormality on your Pap smear." Or: "We found a spot on your X-ray and need to look into this." Or: "One of the measurements on your blood panel was out of line." And then begins the nail-biting time--the hours or days before you get in for a follow-up evaluation. Sometimes that call is the first news of a deadly disease. More often it turns out to be nothing important. The follow-up reveals that the first test was just a fluke or the result of a benign condition. Diagnostic tests are a marvel of medicine, saving millions of lives by picking up diabetes, heart conditions, cancer and other treatable illnesses long before they show symptoms. But they come with a high cost, and not just the money spent on them. There is a very high cost in anxiety. Don't blame the testing laboratories. There is inevitably a trade-off between a test's sensitivity (its ability to spot illness) and specificity (its ability to give a clean bill of health). Says Dr. Jon Nakamoto, an endocrinologist and a lab director for Quest Diagnostics: "Society and the medical community have to make a choice: How often do we get these false positives and how often do we make a difference in the outcome"--that is, save a life. Consider the Papanicolau smear, used to detect precancerous changes in a woman's cervix. It has dramatically reduced the death rate from cervical cancer. But it also causes a lot of needless anxiety. Between 2 million and 3 million women a year get flagged as having some degree of abnormality in their cells. But only one in a thousand of those in fact have a malignancy and are destined to die from it. (Most of the 4,000 deaths per year from cervical cancer are in women who either never had a Pap smear or missed having one in the five years before a cancer diagnosis.) Over their lifetimes, 40% of women get a false alarm Pap. Breast cancer? It's a big killer, and a big source of fear in women who are destined to die of something else. One in four women will, over the course of her lifetime, get at least one false alarm from a mammogram. The test for prostate cancer is a source of intense controversy. Men who get tested for prostate specific antigen, or PSA, have a 13.5% chance of landing in the danger zone. But a man's probability of dying of prostate cancer is only 2.3%. Is the discrepancy due to the ability of the test to detect cancer early and get it treated? Scarcely. A study discovered that PSA screening does not reduce the death rate in men 55 and older. Moreover, to save one patient from a fast-growing lethal prostate cancer, doctors have to subject dozens of patients with slow-growing cancers to debilitating and painful surgery. The PSA test can't distinguish the two kinds of cancer. The doctor who discovered PSA, Richard Ablin, created a furor this year when he said, in a New York Times op-ed, that as a screen of healthy people the test does more harm than good. Patient education is the antidote to angst about positive test results. But a little knowledge is a dangerous thing. Dr. Joel Topf, a kidney specialist in Detroit, recounts the case of a patient whose blood report flagged a measure of kidney performance called the estimated glomerular filtration rate. She came in at 58 milliliters per minute (adjusted for body size). Anything below 60 is supposedly a sign of kidney failure. Trolling the Web, the woman discovered that both her blood pressure medicine and her cholesterol-lowering medicine were linked to cases of kidney damage. She stopped taking them. That was an unfortunate result, he says. The lab number is just an estimate, it's subject to some normal variation and it naturally declines with age. The Web, of course, is a great enabler of hypochondria. But sometimes it's the doctors who are the alarmists. Trisha Torrey, an author and patient advocate in Baldwinsville, N.Y., tells how her life was ruined with a too-hasty diagnosis of subcutaneous panniculitis-like T-cell lymphoma. What's a patient to do? Four tips from Dr. Nakamoto: 1. Follow instructions, such as fasting before your blood test. That's especially important if your doctor is concerned about glucose or LDL/HDL ratios. Caffeine and alcohol can throw off some lab values. 2. If you are planning to run a marathon or work the night shift before the blood is drawn, make sure the doctor knows. 3. Ask for a copy of the lab report, or at least make sure you can get at it from the Web (such as on Google Health). 4. If you have an out-of-range value, get the doctor to explain what it means and what further testing will accomplish. Patients should be self-aware, but they should hesitate before jumping to conclusions. If the disease you think you have is rare, you probably don't have it. 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