Are early detection and treatment always best? – Harvard Health Blog

Throughout my medical career, I’ve heard statements like these:

Early detection offers the best chance of cure.

If you wait for symptoms, you’ve waited too long.

Knowledge is power, and the sooner you have the information, the better.

Over time, I’ve realized they are often untrue. Many health conditions go away on their own. In such cases, early testing may amount to wasted effort, time, and medical cost. Some testing is invasive and has a significant risk of complications. And minor abnormalities may lead to more testing. There’s also the anxiety of waiting for results, or learning you have an abnormality of uncertain importance that requires additional evaluation.

Why wait? Why not just test and treat right away?

Sometimes, the “cure” is the passage of time. That’s one reason many doctors will suggest watchful waiting rather than aggressive testing. Knowledge is only power if there’s something useful you can do with it. And many conditions aren’t worth knowing about or treating until they cause symptoms.

For these reasons, the American Board of Internal Medicine Foundation launched the Choosing Wisely campaign in 2012. Its mission is to encourage more selective, evidence-based testing and treatment, and to discourage unnecessary tests and care.

Six conditions for which early detection and treatment isn’t clearly helpful

  • Certain leukemias and lymphomas. While malignant, some leukemias and lymphomas may progress so slowly that the risks of treatment outweigh the benefits. For example, no therapy may be recommended for early-stage chronic lymphocytic leukemia that is causing no symptoms.
  • Sarcoidosis. This condition of unknown cause often causes enlarged lymph nodes and inflammation in a variety of organs. But when there are no symptoms, a normal physical examination, and normal results of routine testing, no treatment may be warranted.
  • Some types of prostate cancer. For men with prostate
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