Examining the evidence behind a community health screening

The following deceptive advertisement appeared in my church’s bulletin yesterday:

Life Line Screening, the nation’s leading provider of preventive health screenings, will offer their affordable, non-invasive, painless health screenings [in the church cafeteria] on April 9th. Five screenings will be offered that scan for potential health problems related to: blocked arteries, which is a leading cause of stroke; abdominal aortic aneurysms, which can lead to a ruptured aorta; hardening of the arteries in the legs, which is a strong predictor of heart disease; atrial fibrillation or irregular heart beat, which is closely tied to stroke risk; and a bone density screening, for men and women, used to assess the risk of osteoporosis. Register for a Wellness Package with Heart Rhythm for $149. Add Disease Risk Assessment with blood testing & biometrics for $79 more.

Although all of these tests sound good, every one is either 1) scientifically unproven; 2) proven to be beneficial only in certain groups of patients (rather than all adults); or 3) likely harmful in the long run, by increasing rates of false positive tests, subsequent unnecessary diagnostic procedures, and the adverse effects of those procedures.

As you know, until last November I worked for a federally-supported program that reviews the scientific evidence to support screening tests, and based on that experience, I would not offer most of these tests to my own patients, much less market them directly to a church congregation.

Specifically:

1. “Blocked arteries” / stroke screening is most likely a carotid ultrasound scan, which doesn’t help because most patients with asymptomatic carotid artery blockages will not suffer strokes. Although the screening test is “non-invasive and painless,” the confirmatory test, angiography, is not (it actually causes a stroke in a small number of patients) and unnecessary carotid endarterectomy can lead to death.

2. Abdominal aortic aneurysm screening is only recommended in men ages 65 to 75 who have ever smoked, because aneurysms are much less common in younger, female, and non-smoking populations. Even in men who are eligible for the test, it’s important to weigh the potential benefits against the potential harms of corrective surgery, which has a not insignificant mortality rate itself.

3. “Hardening of the arteries in the legs,” or screening for peripheral vascular disease with an arterial-brachial index, hasn’t been provent to prevent heart attacks but will certainly lead to many false positive results.

4. I’ve never even heard of atrial fibrillation (irregular heart beat) screening, which I presume is doing a screening EKG, which is also totally unproven. Absolutely no organizations recommend this.

5. Screening for osteoporosis with bone density testing is the only test on the list that’s actually worthwhile for a large number of adults, especially women over 65. But it’s not appropriate to do this test without a prior consultation with a clinician who can discuss the risks and benefits of undergoing this type of screening. And there are still questions about whether men benefit to the same degree as women, or at all.

In a nutshell, that’s why companies like Life Line have no business portraying these services as “preventive health screenings,” in my church or any other community setting. (I’ve sent an e-mail to my pastor recommending that they be dis-invited for the reasons I’ve outlined above.) It’s one thing to draw blood for a cholesterol test and take someone’s blood pressure (which will cost a whole lot less than $149), and quite another to offer these other procedures which are, at the very least, a waste of money and quite possibly harmful.

Kenneth Lin is a family physician who blogs at Common Sense Family Doctor.

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