As everyone pays more and more attention to health, physical examination has become the "standard of life" for many young people, even if the company's basic benefits do not include annual physical examination, many people are willing to arrange it out of their own pocket.
But when we go to the physical examination center, we will find that according to the recommended physical examination items, it will cost almost thousands or even tens of thousands, is this really necessary?
In fact, many medical examination projects just cost money unjustly.
Tumor marker screening for cancer, in fact, is more suitable for some high-risk groups of cancer, such as alpha-fetoprotein (AFP), it is suitable for combined liver ultrasound, for cirrhosis, hepatitis B / C infection of the population to screen liver cancer.
For the general population, testing for tumor markers with low sensitivity and specificity may lead to overexamine treatment, an increased psychological burden on the person being examined, and other risks.
Image source: Stand Cool Helo
Tumor markers are elevated≠ get cancer
Tumor markers sound like "cancer indicators" and "special business cards of cancer", in fact, the specificity and sensitivity of most tumor markers are not so high.
Their levels are disturbed by many reasons, in addition to malignant tumors, some lifestyle habits or benign diseases can also lead to elevated indicators, such as smoking, gastritis, chronic bronchitis will make carcinoembryonic antigen (CEA) slightly elevated, germ cell tumors or hepatitis infected people liver cell regeneration when the level of alpha-fetoprotein (AFP) will also increase.
Tumor markers are normal ≠ no cancer
Even in patients with tumors, their tumor marker levels may be normal. If you sit back and relax because the results are normal, and neglect the really suitable cancer screening, do not correct bad living habits and treat diseases, but may lead to big mistakes.
However, the examination of tumor markers is relatively simple, and some intermediate and advanced cancers can be found, if you really want to do it, it is not impossible.
Many physical examination institutions claim that "a drop of blood to check cancer", only need fingertip blood to detect tumor cells or genes in the blood, and find early cancer.
But at present, these technologies still face many problems.
For example, the amount of blood taken from the fingertip contains only a very small amount of tumor information. Early-stage cancers are usually confined to very small epithelial tissues, without a large amount of apoptosis, angiogenesis, and do not release many related molecular markers or gene fragments.
Constantly scaling up trace amounts of gene fragments, amplifying detection signals, is prone to errors, and gene fragments released by normal cells into the bloodstream may also interfere with the results.
Even if it is positive, it is difficult to determine whether there is really cancer, from which part, and how to intervene.
Therefore, these thousands and tens of thousands of dollars are basically equal to white flowers.
PET-CT can be said to be the most high-end examination in many people's minds, and it can tell you which part of the area is most susceptible to cancer. It integrates pet and CT two imaging technologies, which can show both the anatomy of the organ and the metabolic level of the organ, and a single examination will cost nearly 10,000 yuan!
But Zhimei does not recommend that you choose it in the routine physical examination!
This is because pet-CT may not be "illuminated" in some cancers and early cancers.
PET in PET-CT is a contrast agent injected into the body, because malignant tumor metabolism is usually faster than normal tissue, will absorb more contrast agent, so it will show a particularly bright image, so that we can observe which places are brighter, we know which places are more metabolic.
But not all malignant tumors will be so "well-behaved", such as stomach cancer, liver cancer, urinary tract cancer is less absorbent of contrast agent, will be "disguised" like normal tissue, and some malignant lesions are still in the embryonic stage, the absorption of glucose will be relatively small, will "shine" out.
In addition to "false negatives", there are also "false positives". Some inflammation, tuberculosis, benign hyperplasia of the abdominal cavity, etc. may also appear because of the strong metabolism, but they are not cancerous.
In addition, PET-CT will produce radiation, although the doctor will control the amount of radiation within the safety standards when examining, but as the number of examinations increases, the risk will accumulate, and the lower the age, the greater the risk, so it is more recommended to do PET-CT according to the doctor's advice, rather than in the general physical examination.
There is an important hub in the heart's supply of blood to the brain, which is the carotid artery. When the carotid artery is narrowed to a certain extent, it affects the blood supply to the brain, and even stroke may occur.
Therefore, many physical examination institutions will recommend young people to do this examination in the name of "preventing stroke".
However, the U.S. Preventive Services Task Force pointed out that for low-risk people without related symptoms, the harm caused by this test may outweigh the benefits, and the prevention of stroke or coronary heart disease is not necessarily to do carotid ultrasound.
This is because the accuracy of carotid ultrasound depends heavily on the examiner's experience and techniques. Operators of medical examination facilities do not necessarily have specialized training in vascular ultrasound screening.
If people who do not have these diseases are misdiagnosed, unnecessary angiography and surgery may be performed, which will increase the risk of stroke.
The "Guidelines for the Prevention and Treatment of Stroke in China" also point out:
There is no direct evidence that asymptomatic carotid artery stenosis can reduce the incidence of stroke. Routine screening is not recommended for low-risk populations.
So who is suitable for carotid ultrasound screening?
At present, it is recommended that friends with the following conditions go to a qualified hospital for carotid ultrasound examination.
Symptoms of cerebral ischemia (eg, postural vertigo, dizziness, vertigo, numbness of the limbs);
Small/major strokes have occurred in the past;
Have a family history of stroke;
There is high blood pressure, smoking, diabetes, hypercholesterolemia, atrial fibrillation, significant overweight or obesity, lack of exercise, etc.
Many physical examination institutions will use X-ray chest x-rays to check lung cancer in the case of insufficient budget, which is actually difficult to detect early lung cancer.
Chest x-ray has its limitations, unlike CT, which only shows a certain section of the lungs, like a thick book being pressed into a thin page.
The heart and the longitudinal and horizontally distributed blood vessels may also overlap with the lesion, so it is still relatively small, or nodules located behind the heart, on the left side of the lung, the edge of the ribs, etc. are difficult to find.
It is often the larger, more obvious lung cancer that is detected.
Therefore, X-ray chest x-ray does not play a big role in physical examination, and it is recommended to choose a low-dose spiral CT with greater sensitivity for screening lung cancer in high-risk groups.
Write at the end
1. The physical examination is not the more expensive the better, the appropriate is the most important.
For some cancers, relatively inexpensive tests are more suitable for screening than expensive ones. For example, stomach cancer, PET-CT sensitivity is as low as 50%, and gastroscopy in addition to more accurate, but also can take biopsy for pathological examination, the cost is much lower, will not bring radiation.
2. If you are unwell, you should see a doctor, the physical examination is only a general examination for healthy people.
3. It is recommended to choose physical examination items according to age, symptoms, family history, living environment, bad habits, etc.
Now many physical examination centers are not suitable for everyone, for example, China recommends starting breast cancer screening at the age of 45, but some people in the family have a mother diagnosed with breast cancer at the age of 40 and a sister diagnosed with breast cancer at the age of 35, so she should start screening around the age of 30.
It is recommended that you choose the physical examination items according to your own specific situation and consult the advice of a professional doctor as much as possible.
4. Genetic testing is more suitable for high-risk groups with a family genetic history of cancer.
At present, scientists have only identified several genetic variants that are related to cancer, such as breast cancer, ovarian cancer, etc., for people with family genetic history, it may be necessary to consult a specialist whether a specific gene needs to be tested to determine the risk of cancer and develop a prevention plan.
People who do not have a family genetic history really discourage expensive "genetic testing" during physical examinations.
5. At present, it is recommended that you can do early screening cancer according to your own situation: breast cancer, cervical cancer, colorectal cancer, lung cancer, liver cancer, stomach cancer. Specific screening methods can be consulted with a doctor.
Reviewers:
Zhang Xiaodong | Chief Physician, Department of Gastrointestinal Oncology, Peking University Cancer Hospital
Gao Ping | Chief Physician of the Department of Neurology, Beijing Hospital
bibliography:
[1] BatesSE,LongoDL.Tumormarkers:valueandlimitationsinthemanagementofcancerpatients. CancerTreatRev1985;12:163-207.
[2] Humphrey LL, Deffebach M, Pappas M, Baumann C, Artis K, Priest Mitchell JP, et al. Screening for lung cancer with low-dose computed tomography: a systematic review to update the U.S. Preventive Services Task Force recommendation. Ann Intern Med, 2013;159:411-20.
[3] Jonas DE, Feltner C, Amick HR, Sheridan S, Zheng ZJ, Watford DJ et al. Screening for Asymptomatic Carotid Artery Stenosis: A Systematic Review and Meta-analysis for the U.S. Preventive Services Task Force. Ann Intern Med 2014; 161(5):336-346.
Wang Wenzhi,Gong Tao. Chinese Guidelines for Primary Prevention of Stroke 2010[J].Chinese Journal of Neurology,2011,44,(4):282-288.
Stroke Prevention and Control Engineering Committee of National Health Commission. Guidelines for stroke prevention and treatment in China[M]. Beijing: People's Medical Publishing House, 2018: 1-568.
[6] Wu CX, Zhu ZH. Diagnosis and evaluation of gastric cancer by positron emission tomography. World J Gastroenterol. 2014;20(16):4574-4585. doi:10.3748/wjg.v20.i16.4574
*The content of this article is a popularization of health knowledge and cannot be used as a specific diagnosis and treatment recommendation, nor is it a substitute for face-to-face consultation by a practicing physician, for reference only.
*The copyright of this article belongs to Tencent Medical Code, unauthorized media reprinting is prohibited, and illegal reprinting will be investigated for legal responsibility according to law. Individuals are welcome to forward to the circle of friends.
* Welcome to WeChat search and pay attention to the public account "Tencent Medical Code" to get more health science knowledge.