Lisa Killinger, DC

The Council on Chiropractic Education (CCE) requires all chiropractic colleges to include training on the recommended health screenings for common health concerns. CCE requirements aside, such screenings should be an important part of every health professional’s practice, and chiropractors are no exception. While a chiropractor may choose not to perform blood tests or other screenings in their offices, it is essential that they recommend such screenings to their patients, and document the results in a patient’s file. Health screenings do save lives and often identify disease early, reducing the need for extensive, invasive medical intervention. Such preventive strategies are quite congruous with chiropractic philosophy. Rather than waiting for a disease to advance to an incurable state, screenings identify risk factors and problems early, often creating opportunities and inspiration for lifestyle changes to lower risk and prevent disabling disease.

Examples of such health screenings are mammograms for the early detection of breast cancer and colonoscopy to detect colon cancer or precancerous polyps.  Over the past few years, the US Preventive Services Task Force (USPSTF) has backed off on its recommendations for several screenings or increased the age of first screening. A point in case, was the change in mammography recommendations for women. Previously, a baseline mammogram was recommended for all women at age 40. Recently, the USPSTF recommended that the baseline mammogram need not be performed until age 50. This change in recommendation ignited a firestorm of controversy. Breast cancer support groups, cancer survivors, and healthcare providers felt that the 10-year delay in baseline mammography was wrong and that such a change would increase the death rates due to breast cancer (many women are diagnosed with breast cancer in their 40s.) This caused several recommending bodies such as the American Cancer Society, etc, to break ranks, each putting forth their own recommendation. After considerable public outcry about raising the age of recommended mammography to age 50, the following statement was issued by USPSTF:

The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient’s values regarding specific benefits and harms.

Why did the USPSTF take such a controversial stance? The simple answer is “evidence.” The USPSTF weighs the cost and risk of screenings against the evidence for lives saved, or the decrease in healthcare costs. If there is no convincing evidence that an earlier test saves more lives or saves healthcare dollars than a later baseline screening age, the recommendation may be changed to reflect that new evidence (or lack of evidence FOR a screening.) Even when unpopular, the growing body of evidence must continually be reviewed to see if a screening is causing more harm than good, or costing more dollars and worry than any measurable decrease in disease or death. As health professionals, we have precious little time to sort through the evidence as it pours in on each healthcare topic. Fortunately, teams of experts, such as the USPSTF, the COCHRANE Collaboration and others assemble, evaluate and summarize evidence in a way that helps us with our own evidence-based clinical practice.

For more information on this topic, please see:

  1. US Preventive Services Task Force: Guide to Clinical Preventive Services 2010-2011. www.guideline.gov 
  1. U.S. Preventive Services Task Force. Screening for breast cancer. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2009 Dec.
 
  1. U.S. Preventive Services Task Force. Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2009 Nov 17;151(10):716-26, W-236. http://www.guideline.gov/content.aspx?id=15429 
 
  1. U.S. Preventive Services Task Force. Screening for colorectal cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2008 Nov 4;149(9):627-37. http://www.guideline.gov/content.aspx?id=13133 
  2. U.S. Preventive Services Task Force. Screening for prostate cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 2008 Aug 5;149(3):185-91. http://www.guideline.gov/content.aspx?id=12827 

 

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