The main purpose of disease screening is to

The core purpose of disease screening has never been to "confirm whether you are sick now", but to identify risks before symptoms appear, or even when the disease is still in its reversible budding stage, and to avoid subsequent more serious health damage with minimal intervention costs. It is essentially the most cost-effective line of health defense that ordinary people can take the initiative to grasp.

Last year, I helped with two-cancer screening education at a community public health station. I met Aunt Zhang, who lived in a home for elderly people. She refused to come at first, saying that she had no soreness in the waist or stomach, and that there was nothing wrong with her. Drawing two tubes of blood and doing an examination was just a hassle. In the end, the community staff came to persuade her three times before reluctantly coming. As a result, she was found to have high-risk HPV types 16 and 18, and TCT showed low-grade lesions. Subsequent colposcopy biopsies did not show precancerous lesions, so she took topical interferon for three months and adjusted her schedule. Half a year later, the reexamination turned negative. Later, Aunt Zhang specially brought a bag of oranges to thank us, saying that her sister had been bleeding from her lower body the year before last, so she went for a check-up, and was found to have late-stage cervical cancer. After spending hundreds of thousands, she still couldn't keep her. "If I had waited until the pain was gone, she might have been lying on the hospital bed now."

Although the benefits of screening are obvious, the academic community has been arguing about the "boundary of screening" for almost ten years. It is not at all what everyone thinks: "the more comprehensive the screening, the better, and the more frequent the screening, the better." Take thyroid cancer screening as an example. In the past few years, thyroid ultrasound was included in routine physical examinations. Many physical examinations revealed small nodules, which was so scary that many people had their thyroids removed and had to take Euthyrox for the rest of their lives. However, mainstream European and American guidelines no longer recommend routine thyroid cancer screening for ordinary healthy people. The core reason is that more than 90% of papillary thyroid cancers are indolent and will not progress throughout their lives. Screening out the cancer can easily lead to over-treatment, leaving patients to bear the risks of surgery and the burden of lifelong medication.

I met a 27-year-old young man in the outpatient clinic before. He works on the Internet and is always afraid of sudden death. He spends three to four thousand for a full set of tumor markers and cardiovascular and cerebrovascular screening every year for physical examination. Last year, it was found that CA724 was twice the normal value. He was scared to death. Gastroscopy, colonoscopy, full abdominal CT, PET-CT was done all over, but nothing was found. Finally, it was discovered that he had a dinner with colleagues the night before the physical examination. He ate two kilograms of drunken crabs and a large pot of spicy hot pot. The indicator was increased stress. Not to mention that he suffered tens of thousands of yuan in vain. In that month, he suffered from insomnia due to anxiety and his blood pressure was much higher.

Nowadays, scholars in the field of public health prefer to calculate "group accounts": Take colorectal cancer screening as an example. If 1,000 people over 40 years old are given free colonoscopy, they can probably screen out 10 adenomatous polyps and 2 early colorectal cancers. Removing the polyps can prevent subsequent development of cancer. , the cure rate for early-stage cancer is close to 100%, and the ratio of overall medical insurance investment and public health benefits is extremely high. my country's rural cancer screening projects in the past 10 years have helped at least 1.2 million women detect precancerous lesions of cervical cancer and breast cancer early. This benefit is real. However, many doctors on the clinical side prefer "individual precision": ordinary people do not need to follow the group screening program to make up the numbers. If you are only 20 years old, have no family history of cancer, and do not have high-risk habits such as long-term smoking and drinking, there is no need to undergo lung cancer screening or gastrointestinal endoscopy screening. If you find no problem, it is a waste of money, but if you find a small abnormality, it will only increase anxiety.

In fact, screening is like doing regular maintenance on your home. You don't wait for water pipes to burst or circuits to burn before you find the problem. Instead, you need to feel for leaks in the water pipes and smell the burnt smell from the wires from time to time. If you find a small problem, you can just put some glue or replace a section of wire to solve it. But if there is a serious accident, you will have to tear down the floor and smash the wall, which will cost you ten times more money.

I currently only have a few screening items every year: basic blood and urine routine, liver and kidney function, plus a low-dose chest CT - my dad has a family history of lung cancer, and I smoke occasionally, so I am a high-risk group for lung cancer. It is necessary to have annual screening after the age of 35.； I have a thyroid ultrasound every two years, and I plan to have a gastrointestinal endoscopy every year after I turn 40. I won’t touch any other fancy tumor markers or genetic screening because it’s unnecessary.

In fact, to put it bluntly, no matter how noisy the academic community is, the core purpose of screening has never changed: it is not to find you diseases, but to help you prevent them. Just don’t go to the two extremes: Either you refuse to be screened, you think you are in great health and there is nothing wrong with you, and it’s too late to get tested when you have symptoms. ； Either you are overly anxious and have to do all the screenings. If you find out any trouble, you will be scared to death, and you will suffer from other problems. What suits you is the best.