The consequences of false positives in disease screening mainly refer to

The core consequences of false positive disease screening refer to the additional health damage, economic costs, psychological burden, and associated waste of social medical resources due to the incorrect "abnormal/positive" screening results for subjects who do not originally suffer from the target disease.

Let me tell you a true story that I encountered when I was doing a public health project on cancer screening in the community two years ago. 42-year-old Sister Zhang is usually in good health and rarely catches a cold. When she participated in the free cancer screening for the first time, the high-risk HPV test showed positive. She became red-eyed on the spot and sat at the door of the clinic for half an hour with the report in hand without moving.

After that, she underwent colposcopy and cervical biopsy according to the procedure. After the operation, she bled for almost ten days, and developed a minor infection. She took antibiotics for a week. In the end, the results of the biopsy and HPV typing review were all negative - which meant that all the sins of the past half month were in vain. Many people still think of false positives as "false alarms," ​​but in fact, the health risks brought by invasive reexamination are not false at all. I have also seen patients whose lung screening revealed ground-glass nodules. They asked the doctor to cut half of a lung lobe. In the end, the pathological results were just ordinary inflammatory nodules, and their lung function was damaged by at least 10%. Of course, there are many doctors on the clinical frontline who hold the attitude of "preferring a wrong diagnosis to a missed diagnosis". After all, if a case of late-stage cancer is missed, it is 100% tragic for the patient. However, the algorithm in the field of public health epidemic screening is actually very clear: when the population prevalence of the target disease is less than 1%, the number of false positives screened will be 5% of the true positives. -10 times, for example, the PSA prostate cancer screening data collected by the US Centers for Disease Control and Prevention in the early years: for every 1,000 men screened, only 3 were eventually diagnosed with prostate cancer, and the number of false positives was as high as 120. At least 80 of these 120 men will receive unnecessary needle biopsies or even over-treatment.

Physical suffering is secondary. Many people have not calculated the hidden economic costs behind false positives. Let’s talk about Sister Zhang. From the initial positive test to the final negative test, she did 5 tests. After being reimbursed by medical insurance, she paid more than 1,200. I also met a young man who did a physical examination before. The tumor marker CA199 was slightly elevated, and he had a gastroscopy, Colonoscopy, abdominal contrast-enhanced CT, and finally a PET-CT at my own expense due to worry, which cost nearly 20,000. In the end, it was found out that it was just because I stayed up late every day to catch up on projects during that period, and the indicators temporarily increased due to chronic cholecystitis, so all the money was wasted. There is a lot of controversy in this field. For example, many people question that commercial medical examination institutions will deliberately relax the positivity threshold. After all, reexamination and in-depth examinations caused by abnormal results are real revenue-generating points. However, there are also practitioners in the medical examination industry who are complaining: the threshold is really tightened and diagnosis is missed. No one can bear the responsibility if the family members make trouble, and they can only balance both ends.

What is most easily overlooked is the psychological trauma caused by false positives. This thing is invisible and intangible, but the impact may last for several years. During that time, Sister Zhang couldn't go to class, couldn't eat, lost 7 pounds in half a month, and even secretly wrote half of her will. She was afraid that she had late-stage cervical cancer, which turned out to be a negative result. It took her almost three months to let go of the matter. And the young man I mentioned earlier was delayed for more than a month because of abnormal CA199, and he almost lost his job offer. During that time, he had insomnia every day, and his blood pressure rose to 140/90. When the final reexamination results came out, he said that during that time, he even thought about "how to arrange for his parents to care for him if he has cancer." There has been a previous follow-up study of psychosomatic medicine. It was found that within 6 months after receiving the results, false positive subjects were 3.2 times more likely to develop anxiety and depression than the general population. Many people even developed stress-related physical symptoms and actually suffered from problems. Of course, some people think that this anxiety is nothing compared to the risk of missed cancer diagnosis. It can only be said that people with different positions have completely different ways of settling accounts.

I have been working in public health for so long, and every time I screen residents, I will clearly explain the probability of false positives. I am not advising everyone not to do screenings, but I hope everyone will be cautious when they get abnormal results. Don't panic and seek evaluation from a specialist. Evaluate the risks and then decide whether to take the next step of examination. After all, the original intention of screening is to help us live healthier. If we suffer, waste money, and scare half our lives because of a wrong positive result, it will be too much.