"Screening tests for cancer usually don't actually make the diagnosis. Usually screening tests are just the first step. And then if they're positive, they need to be followed up with a confirmatory test. So for example, mammogram may show a lesion in the breast that doesn't look right. That alone doesn't make the diagnosis. It needs to be followed up with a biopsy to determine if the finding on the mammogram is benign or non-cancerous or malignant. Cancerous. Are there any downsides to screening? There are. We can have false positives where the screening test seems to indicate a problem, and there is no underlying problem. On the flip side of the coin, we can have false negatives, where the screening test comes up negative, in fact, there is a cancer hiding and the test was wrong. There can be anxiety associated with cancer screening, and there can be complications from the tests used to diagnose. There's also a concept called over-diagnosis. Most of us, when we hear the word cancer imagine the worst. We imagine it starts, it grows, it causes symptoms, it spreads and causes death. But I'll tell you that there are many cancers that we find nowadays that never progress, never spread and never cause death. It sounds like a foreign concept. Why would it even be called cancer if it doesn't grow, spread and cause death? Tests have become so sophisticated nowadays, that we do find cancers that are so small that either never grow or grow so slowly that in anyone's lifetime, it would never cause a problem. When we diagnose these insignificant cancers, the term is called over-diagnosis. And many patients feel, why is this a problem? Why not know about something anyway, even if it's not going to cause a problem? The issues are that this can create unnecessary anxiety. In some patients, even though they may say they're okay with not doing anything, develop so much anxiety that they feel compelled to treat a cancer that was never actually going to harm them. This is the problem with over-diagnosis."
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