Every year in the US most americans get an annual physical from our doctor if we have insurance. It usually consists of getting some bloodwork done, vitals basic questions etc. Then going over those results and any concerns you may have and nothing else.
I always hear those horror stories of people just all of a sudden being diagnosed with stage 4 cancer and theres nothing that can be done. Maybe im missing something.
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There are a lot of different kinds of cancer and hence a lot of different screening tests involved. Doctors will usually order routine screening that is most effective at identifying the most common types of cancer as people get older or at higher risk.
In addition, not everyone gets their annual physical, and many types of cancer, especially aggressive types, can grow from unnoticeable to very serious in much less time than a year.
As a result, annual physicals don’t, and can’t, test everyone for every kind of cancer.
Two things: billing and coding. The US hospital system is very corrupt and is funded by a confusing beauracracy. They can bill you everytime you show up and so they do as much as they can to move you to specialists and from room to room.
Screens are very complicated indicators. Getting the right screens at the right time involve lots of factors.w The best example is prostate cancer. Almost all men who grow old will die with prostate cancer. Not of but with. This means if we treated all those old people for the cancer their lives would actually get worse. It’s harder than it seems
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Well they do recommend breast and colorectal cancer screenings after a certain age, due to their relatively high incidence rates and high likelihood of being identified by simple-ish scans.
The problem with a generalized “all cancer” scan is that every cancer is unique, and how you test for them and locate the tumors varies.
Putting someone through a full body MRI every year would probably be counterproductive – you’d do more damage discovering and operating on benign cysts, very slow growing tumors, and other harmless medical oddities than you’d save by discovering actual cancers of concern. The “false alarm” rate would be pretty high.
A lot of people walk around their entire lives with undetected cysts or tumors somewhere that never cause a problem. Doctors are hesitant to screen them all down and perform unnecessary treatments.
Women get routine pap smears (not always yearly) as adults and routine mammograms at 40+. Both of these are cancer screenings for the most common types. Men get prostate exams for the same reason. Colonoscopies are now recommended at 45, again to find a common but treatable cancer early.
As someone with cancer, mine does not show up on standard blood work unless the person doing the diagnoses of the draw knows I have cancer and then they can maybe confirm I still have cancer. Same for urine tests with me. So really it’s only CT scans that confirm my cancer. Maybe everyone should have a CT scan once a year, but given the US is a living hell scape when it comes to medical insurance, I’d say we’re closer to curing cancer than everyone suddenly having the option of a scan once a year.
There is a problem with false positives. Say the rate for false positives is 0.1%. Not bad, right. Wrong. Say you screen a million people, and a thousand of them get a false positive. They go for another, more invasive test, and get a biopsy. Then there’s the risk of complications from the biopsy, the expense, etc. Our health care system would be busy with too many tests and not enough actual treatment
In most cancer screening procedures, the recommendation for a screening is weighted against the risk of harm from getting the test done, since the risk is not zero
As others have posted, scanning and learning about a disease can be as harmful, or more harmful than, the disease itself in many cases. Borrowing from the [overkill](https://www.newyorker.com/magazine/2015/05/11/overkill-atul-gawande) essay (2015) by Atul Gawande.
*…. Another powerful force toward unnecessary care emerged years after Arrow’s paper: the phenomenon of overtesting, which is a by-product of all the new technologies we have for peering into the human body. It has been hard for patients and doctors to recognize that tests and scans can be harmful. Why not take a look and see if anything is abnormal? People are discovering why not. The United States is a country of three hundred million people who annually undergo around fifteen million nuclear medicine scans, a hundred million CT and MRI scans, and almost ten billion laboratory tests. Often, these are fishing expeditions, and since no one is perfectly normal you tend to find a lot of fish. If you look closely and often enough, almost everyone will have a little nodule that can’t be completely explained, a lab result that is a bit off, a heart tracing that doesn’t look quite right.*
Modern medicine has evolved to treat all cancers aggressively independent of expected outcomes. Aggressive scanning can lead to aggressive treatment and low value or unnecessary care.
Also, highly recommend the books Better and Being Mortal by Atul Gawande which touch on similar challenging topics.
There’s not one test out there that can tell you if you have cancer or not. Maybe a PET scan could, but I don’t know what the ramifications would be of getting a PET scan yearly (since they use radiation). Also, PET scans can’t detect every kind of cancer, just like bloodwork can’t.
Based on your medical history, you actually might get screenings wrapped in with your physical every year. If you have a family history of cervical cancer, you’ll get PAP smears more regularly. And between certain ages, PAP smears are done during annual physicals for women.
The main reason is that insurance won’t cover it unless there is a reason to. The tests to search for 100s of different types of cancers are not cheap. Even tests like routine colonoscopies are a hassle to get insurance to cover unless you meet certain criteria. Must be 40 or older unless you have a family history and then it is 35.
Second is the rate of false positives is fairly high when doing tests for broad spectrum things without having a reason to look for something specific. A [study](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0281153) done on rates of false positives for 5 types of cancer and 6 STIs found that 85.5% of women and 38.6% of men will recieve a false positive.
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