Skip to main content

Main menu

  • Home
  • COVID-19
    • Articles & podcasts
    • Blog posts
    • Collection
    • News
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
    • Career Ad Discount
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2021
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN

User menu

Search

  • Advanced search
CMAJ
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN
CMAJ

Advanced Search

  • Home
  • COVID-19
    • Articles & podcasts
    • Blog posts
    • Collection
    • News
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
    • Career Ad Discount
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2021
  • Visit CMAJ on Facebook
  • Follow CMAJ on Twitter
  • Follow CMAJ on Pinterest
  • Follow CMAJ on Youtube
  • Follow CMAJ on Instagram
Letters

Doing any test is not better than doing no test

Lisa K. Freeman
CMAJ November 01, 2016 188 (16) 1181; DOI: https://doi.org/10.1503/cmaj.1150129
Lisa K. Freeman
Public Health and Preventive Medicine, Alberta Health Services and University of Alberta, Edmonton. Alta.
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Metrics
  • Responses
  • PDF
Loading

Murray’s letter repeats a common mistake in thinking about screening, that “doing any test is better than doing nothing at all.”1 In fact, sometimes doing nothing is better than doing something: more is not always better.2

There are risks and harms with all medical interventions including screening.3 It is imperative not only that cancer screening programs find malignancies early but also that they yield more benefit that harm: harm generally arises from false-negative results, false-positive results and overdiagnosis.4

Although the risk of a false-negative result may be mitigated by repeat screening, it may also lead to harm.4 A person falsely reassured may continue an unhealthy lifestyle and be less likely to return for repeat screening.5 A false-positive result often leads to a cascade of increasingly invasive medical interventions, as well as the psychological distress of becoming a patient and being labeled as “ill.”4,5

Specific to colonoscopy are a number of risks. Murray correctly states that a 1:1000 risk of perforation is rare,1 but rare events add up quickly when numerous people are screened. With millions of Canadians eligible for colon cancer screening, rare risks are not negligible.6

It is true that people with “symptoms … will need to be investigated.”1 However, these people are not being screened.6 Screening is meant to catch disease early and is carried out on apparently well asymptomatic people. Though the current evidence does not support the use of colonoscopy for population-based primary screening — hence, colonoscopy is not recommended as a primary population screening test6 — colonoscopy does have other roles in health care.

References

  1. ↵
    1. Murray I
    . Colonoscopy as best screening test not proven [letter]. CMAJ 2016;188:973.
    OpenUrlFREE Full Text
  2. ↵
    Choosing Wisely Canada. Why more medicine isn’t always better medicine: appropriateness of care and choosing wisely. Available: www.choosingwiselycanada.org/resources/videos/2015/02/19/choosing-wisely-canada-more-medicine-is-not-always-better-medicine/ (accessed 2016 Sept. 25).
  3. ↵
    1. Wintermute K,
    2. McDonald K,
    3. Huynh T,
    4. et al
    . Addressing overuse starts with physicians: Choosing Wisely Canada. Can Fam Physician 2016;62: 199–200.
    OpenUrlFREE Full Text
  4. ↵
    1. Barrett B,
    2. McKenna P
    . Communicating benefits and risks of screening for prostate, colon, and breast cancer. Fam Med 2011;43:248–53.
    OpenUrlPubMed
  5. ↵
    1. Marteau TM
    . Psychological costs of screening. BMJ 1989;299:527.
    OpenUrlFREE Full Text
  6. ↵
    Canadian Task Force on Preventive Health Care. Recommendations on screening for colorectal cancer in primary care. CMAJ 2016;188:340–8.
    OpenUrlFREE Full Text
PreviousNext
Back to top

In this issue

Canadian Medical Association Journal: 188 (16)
CMAJ
Vol. 188, Issue 16
1 Nov 2016
  • Table of Contents
  • Index by author

Article tools

Respond to this article
Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CMAJ.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Doing any test is not better than doing no test
(Your Name) has sent you a message from CMAJ
(Your Name) thought you would like to see the CMAJ web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Doing any test is not better than doing no test
Lisa K. Freeman
CMAJ Nov 2016, 188 (16) 1181; DOI: 10.1503/cmaj.1150129

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
‍ Request Permissions
Share
Doing any test is not better than doing no test
Lisa K. Freeman
CMAJ Nov 2016, 188 (16) 1181; DOI: 10.1503/cmaj.1150129
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • References
  • Responses
  • Metrics
  • PDF

Related Articles

  • Colonoscopy as best screening test not proven
  • Palliative care most effective when invisible
  • PubMed
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Venlafaxine-induced hypoglycemia
  • Respiratory syncytial virus and palivizumab prophylaxis in the COVID-19 era
  • Eliminating racism in research
Show more Letters

Similar Articles

Content

  • Current issue
  • Past issues
  • Collections
  • Sections
  • Blog
  • Podcasts
  • Alerts
  • RSS
  • Early releases

Information for

  • Advertisers
  • Authors
  • Reviewers
  • CMA Members
  • Media
  • Reprint requests
  • Subscribers

About

  • General Information
  • Journal staff
  • Editorial Board
  • Governance Council
  • Journal Oversight
  • Careers
  • Contact
  • Copyright and Permissions

Copyright 2021, CMA Joule Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

To receive any of the resources on this site in an accessible format, please contact us at cmajgroup@cmaj.ca.

Powered by HighWire