Most Face Below-Average Risk for Illness
Written by Editor   
Friday, May 08, 2015 12:00 AM

A pair of researchers, in an essay online April 14 in Annals of Internal Medicine, reminds us that most patients have below-average odds of getting most illnesses and of benefiting from most treatments.  They caution against doing too much screening for disease and treating too many people unnecessarily based on the results.

Take lung cancer, for example. The risk for a typical American of developing this at some point is about 7.5%. But really, the risk for smokers is as high as 20% and the risk for nonsmokers is about 1%. "Lung cancer screening isn't even recommended for all smokers, let alone nonsmokers," one research said. "Screening generally does more harm than good for people who are at low risk."

The discussion about risks and benefits for treatment get murkier with other conditions, such as prostate cancer or heart disease, he said.

The researchers make a case for giving drugs to prevent heart attacks to healthy people with high cholesterol who have never had a heart attack before.  For a person who has a 20% risk of a heart attack over the next decade, taking a pill to cut that risk in half, to just 10%, may be worth any side effects that accompany the medication, but for somebody with just a 4% risk, halving that to 2% may not be worth the side effects of taking the pill, the researchers said.

The essence of the message is that physicians and patients should be careful to suggest or request screening, prevention, or treatment interventions and that they should be considered carefully based on the available evidence for that particular patient.  In many cases, part of that personalization will include a discussion of the patient's priorities.