Consider Carefully: 7 Medical Tests That Doctors Suggest You Could Avoid
Unnecessary screenings may lead to unwarranted stress, false positives, and harmful exposure—here’s why you might want to reconsider them.
Are routine medical screenings always beneficial? Each year, millions of Americans willingly participate in these tests with the intent of safeguarding their health. Yet, emerging evidence indicates that certain screenings may be unnecessary and potentially jeopardize one’s well-being. The High Price of Excessive Medical Screening The United States spends twice as much on health care per person compared to other industrialized nations, yet the returns in terms of life expectancy are dishearteningly meager. Despite the high expenditures, the United States lags behind twelve high-income countries in numerous health indicators.While America tops the charts in screening rates for breast and colorectal cancer, second only to Sweden and the Netherlands respectively, the efficacy of such frequent screenings is debatable.”Over-testing is at the root of many of our problems,” report Dr. Jerome Greenberg and Dr. Jonas B. Green in an American Journal of Medicine commentary. They highlight that when tests are unnecessary, “time can be more appropriately spent counseling patients, listening to them, and redoubling efforts to follow well-supported preventive guidelines.”A recent JAMA review reveals that up to $935 billion in annual health care spending is wasted, a substantial portion resulting from unnecessary tests or procedures. Drs. Greenberg and Green highlight that over-testing often stems from the “belief that ordering many tests will help detect subclinical disease, defensive medicine, lack of knowledge, patient expectations, and profit” motives.Over-screening carries a significant economic burden, but its human cost is even more profound. Unwarranted tests can result in anxiety, false alarms, and harmful exposures. Drs. Greenberg and Green emphasize that the drawbacks—low diagnostic yield, high costs, and the emotional strain of false positives—are often overlooked when prescribing screenings for asymptomatic individuals. 7 Tests You May Not Need, and That May Even Cause Harm 1. Cardiac Stress Test Cardiac stress tests, commonly used to identify coronary artery disease (CAD), require patients to exercise on treadmills or stationary bikes as their heart rate and blood pressure are observed.Occasionally, doctors who want a closer look may recommend a nuclear stress test, where a radioactive substance is used to visualize the heart, exposing patients to radiation equivalent to around 400 chest X-rays. Eight million of these tests are performed in the United States each year.Related StoriesDespite their prevalence, the reliability of these tests for indicating heart health is under scrutiny. Experts point out that a stress test mainly “detects only significant coronary stenosis and does not identify nonobstructing plaques,”—a common cause of heart attacks. Thus, an “all-clear” from such tests could be misleading.Inaccurate stress test results have considerable consequences—nearly three percent of recipients undergo additional procedures, and 1.7 percent experience severe adverse reactions, often in individuals without CAD.A study in the Annals of Internal Medicine amplifies this concern, estimating that unnecessary cardiac stress tests, particularly those involving imaging, cost the U.S. health care system $501 million annually and could lead to approximately 500 cancer cases yearly.Cardiac stress tests are best reserved for symptomatic patients or those at high risk of disease. Recent advice from health experts recommends against routinely using imaging stress tests to investigate common symptoms such as heart palpitations or feeling faint. 2. Coronary Calcium Scan Coronary artery calcium (CAC) scans aim to detect calcium, a plaque component, in the heart’s arteries, identifying early signs of CAD. Despite becoming more common, the effectiveness of CAC scans in preventing cardiovascular events remains contested.While calcification can suggest a risk of cardiac events, the test fails to identify soft or non-calcified plaques, which are prone to rupture and cause heart attacks. Therefore, relying exclusively on calcium scoring could underestimate the risk of CAD.In an editorial, Dr. John Mandrola and Dr. Andrew Foy express concerns, noting, “Potential harms from coronary artery calcium testing include radiation exposure … incidental findings in up to 40% of scans, misdiagnosis, and downstream testing.”For patients at both low and high risk of CAD, a coronary artery calcium score may not offer meaningful, actionable insights. Drs. Mandrola and Foy warn, “Atherosclerosis is a complex lifelong disease, and wrongly simplifying it with coronary artery calcium testing helps the testers more than the tested.”Coronary calcium scans best serve high-risk individuals or those experiencing symptoms of CAD. 3. CT Scan or MRI Diagnostic imaging has proven invaluable in detecting and treating various health conditions early. Yet, with the United States conducting 245 computerized tomography (CT) scans and 118 magnetic resonance imaging (MRI) per 1,000 people, it surpasses the usage rates of most developed countries.Despite their merits, these scans are not without drawbacks. A common issue is what experts describe as “radiographic incidentalomas.” These unexpected abnormalities can lead to unnecessary additional tests, treatments, and anxiety for patients.CT scans expose patients to radiation, equivalent to seventy times that of a chest X-ray, potentially contributing to thousands of cancer cases annually. Additionally, concerns have arisen regarding the contrast dyes used in these scans, which may cause allergic reactions, leave trace deposits in the brain, or lead to severe neurological problems such as those seen in gadolinium deposition disease.The frequent reliance on these scans can result in a high number of false positives. For instance, while 95 percent of scan recipients may receive abnormal results, less than 2 percent of these results point to malignant cancers.In the past decade, there has been a surge in people seeking whole-body CT scans or MRIs for early disease detection. Nonetheless, in April 2023, the American College of Radiology warned, “There is no documented evidence that total body screening is cost-efficient or effective in prolonging life.” They, along with other experts, alert the public to the risks of unnecessary procedures and stress. 4. Bone Density Scans Bone density scans, known as dual-energy x-ray absorptiometry scans, are a common tool for assessing osteoporosis risk by measuring bone loss in the spine, hips, and wrists. Despite their utility, particularly for postmenopausal women and individuals with a history of fractures or osteoporosis risk factors, research questions the necessity of their routine use across the broader population.A study involving 6,150 women revealed that many osteoporosis drug prescriptions may be unnecessary and based on potentially unreliable bone density scans. Notably, two-thirds of these prescriptions were based on scan abnormalities not recognized by international guidelines as definitive proof of osteoporosis, with half given to younger women without risk factors.The scans employ a minimal amount of ionizing radiation, much less than a chest X-ray or a CT scan. While generally considered low-risk, radiation exposure adds up. Incidental findings, or unrelated abnormalities picked up during the scan, may also lead to further tests, costs, and anxiety for the patient. 5. Colonoscopies The colonoscopy is celebrated as a highly accurate diagnostic tool for detecting colorectal cancer, consistently proving its ability to identify the disease early.Most individuals are advised to begin colon cancer screening at age 45. If no adenomas or cancer are found, and there are no risk factors, the next screening is usually scheduled ten years later—although this guideline isn’t always followed.A study found that of more than 24,000 patients with precise colonoscopy results, nearly half underwent another test within seven years despite no clear indication.Despite their importance for early detection, colonoscopies carry risks including heavy bleeding, colon tears, diverticulitis, and abdominal pain. For those with cardiovascular issues, complications can occasionally lead to treatments such as blood transfusions, surgery, or hospitalization, and though rare, may even be fatal.A recent study published in The New England Journal of Medicine questions the perceived benefits of colonoscopies, suggesting that their effectiveness in reducing cancer deaths might have been overestimated.Less invasive alternatives for colorectal cancer screening exist. The fecal immunochemical test (FIT) detects hidden blood in stool samples with 80 percent accuracy. Similarly, the Cologuard test searches for atypical DNA and blood traces, indicating potential precancerous polyps or colorectal cancer. 6. Prostate Screening Test (PSA) Routine for men’s health checks, prostate cancer screenings are being reevaluated for their necessity following recent findings. The commonly used prostate-specific antigen (PSA) test is under scrutiny amid concerns that it may do more harm than good.Nearly 70 percent of men age 70 to 80 may have some cancer cells in their prostate, though not all cases warrant concern. The American Academy of Family Physicians asserts that PSA-based screenings frequently identify benign tumors, potentially leading to unnecessary and risky treatments.A concerning trend was highlighted in a JAMA study: Between 2016 and 2018, 38 percent of men aged…
