Disease screening form

There is no universal screening list suitable for everyone. A truly useful screening form must match the three core variables of your age, family history, and long-term living habits. Blindly copying the general form online will either miss risks, waste money, or even bear unnecessary risks of radiation and invasive examinations.

I have worked as an assistant in the physical examination department for two years. I have seen too many people who use the "most comprehensive cancer screening form" found on a certain website to start a project. The one that impressed me most was when I accompanied my aunt for a physical examination last year. She just turned 40. The Internet said that comprehensive cancer screening is required and PET must be prescribed. -CT, the old doctor who was being consulted directly marked the order: "If you have no family history and no history of smoking all year round, why do you do this? The radiation you take is equivalent to taking 300 consecutive chest X-rays. If you really want to check for lung cancer, a low-dose CT only costs more than 200 yuan. Isn't it more useful than this?"

Speaking of which, the controversy over screening standards in the preventive medicine circle has never stopped. The US Preventive Medicine Task Force (USPSTF) is notoriously conservative. For example, lung cancer screening requires people over 55 years old and a smoking history of more than 30 pack-years before it is recommended. Colon cancer screening is not started until the age of 50. The core logic is to pass On the contrary, excessive screening will lead to excessive medical treatment - for example, many people are diagnosed with 3mm pulmonary nodules, and they only need to be followed up every year. However, they are so anxious that they have to have surgery to remove them, which inadvertently damages their lung function. Some people have false positives when they check tumor markers, and they go back and forth for a month to do various tests. In the end, it was just because they stayed up late and drank alcohol the day before.

However, in domestic clinical scenarios, many front-line doctors’ recommendations will be a little more relaxed. After all, the age of onset of cancer in our country is 5-10 years earlier on average than in Europe and the United States. There are still too many people who do not have the habit of regular physical examinations. In many cases, the disease will be in the middle and late stages when symptoms appear. For example, many domestic clinical guidelines for lung cancer screening have lowered the starting age to 40 years old. If you smoke all year round, are exposed to oil fumes when cooking, or have a dusty working environment, it is completely reasonable to advance the screening age by three to five years.

In fact, the universal screening form is like a one-size-fits-all T-shirt. A person who weighs 100 pounds will look awkward in it, while a person who weighs 150 pounds will feel uncomfortable in it. To really fit it, you have to adjust it according to your own situation. For example, girls in their early 20s should not be fooled by medical examination institutions into doing cervical cancer genetic screening worth thousands of dollars. It is enough to get the HPV vaccine before the age of 26 and do TCT every 2-3 years. My cousin was deceived by salesmen and spent 3,800 on a full set of gynecological genetic screening in the first year of her job. When she showed it to a gynecologist, they directly said, "This result has no reference significance for you, and it is a waste of money."

If two or more immediate relatives in the family have suffered from the same cancer, it is not an exaggeration to move the screening age forward by 10 years. My high school classmate’s father and grandfather both had colon cancer. He had his first colonoscopy at the age of 30, a full 10 years earlier than the age of 40 according to the general guidelines. Two adenomatous polyps were found during the first examination and were immediately removed. If he had waited until the age of 40 for another examination, he might have been at risk of malignant transformation.

Don’t be superstitious about “the more expensive the project, the better.” I really need to say a few words on this point. I once met a boss who came for a physical examination. He immediately said, "Give me the most expensive package that can detect all cancers." The doctor finally persuaded him to go back. There is no technology that can detect all cancers with one drop of blood. PET-CT is not a routine screening program. It is used to detect metastases in patients who have been diagnosed with cancer. It is a waste of money and radiation for healthy people.

Of course, if you really find it troublesome and don’t want to go through your medical history and habits one by one, doing a basic hematuria routine, liver and kidney function, blood pressure and blood sugar, and abdominal B-ultrasound every year is better than doing nothing at all. If there is a real problem, most of the basic items will reveal some signs, and it’s not too late to conduct further investigations. If you are not sure what items to add, go to a community health service center to fill out a free health assessment form, or talk to a general practitioner for 10 minutes and explain clearly your usual discomforts, family history, smoking and drinking habits. The list they give you is more reliable than searching ten general lists online.

After all, the essence of screening is never to "do all the items again", but to single out your own high-risk items and keep an eye on them. That's enough.