The picture above shows a PSA test item in the physical examination. PSA is a prostate-specific antigen, which is mainly used to screen prostate cancer. Because the incidence of prostate cancer in people under 50 is extremely low, people over 50 need PSA screening. If we just pile up a large number of inspection items, we can't achieve the goal of accurately screening diseases.
Myth 2: You don't need to consult a doctor for physical examination.
Most physical examinations will have some packages, but whether such packages are set reasonably is directly related to the professional level of doctors. Let's take Angelina Jolie as an example. She had her breasts and ovaries removed. Why? Because her mother and menstruation are both breast cancer patients, it is precisely because she has a strong family history that doctors discovered that their family has a genetic mutation in breast cancer. Therefore, for Angelina, if she doesn't have a mastectomy, she needs to screen for breast tumors earlier than normal people.
So the doctor's consultation is helpful to find some high-risk groups. At present, basically all the packages are aimed at ordinary risk groups, and doctors need to judge high-risk groups to have better directivity.
Myth 3: Dropping blood to detect tumors
The so-called "blood drop tumor examination" is to judge whether a person has a tumor through the examination of tumor markers in blood. This is actually an abused exam. I once wrote a popular science article called "Tumor Markers Overinvestigated" to give you a detailed understanding.
In fact, except alpha-fetoprotein, prostate specific antigen and CA 125 combined color Doppler ultrasound, other tumor markers, such as carcinoembryonic antigen, CA 153 and CA 199, have no screening significance.
Some people may ask, doctor, you say that tumor markers are meaningless for screening, so why are they called tumor markers? Tumor markers are more commonly used in tumor monitoring. For example, after a definite diagnosis of colorectal cancer, some people will find that their carcinoembryonic antigen concentration will increase, and doctors can use this change in carcinoembryonic antigen concentration level as a judgment to monitor whether the tumor has recurred. If the concentration of carcinoembryonic antigen continues to increase after operation, it is suspected that the tumor has recurred, but most tumor markers are only used to monitor whether the tumor has recurred, and cannot be used for screening because of the high false negative rate and false positive rate.
For another example, the carcinoembryonic antigen of smokers is higher than that of normal people, so if we take the results of a tumor examination and show that carcinoembryonic antigen is slightly increased, which is between 1-2 times of the normal range, it is a very embarrassing thing for clinic. Therefore, it is generally not recommended to blindly screen tumor markers.
Myth 4: Genetic testing
The so-called "genetic examination" is mainly aimed at the genetic examination of tumors (see the above table). There are hundreds of genes related to tumors, of which only 5% tumors are hereditary, and many of these 5% tumors have family history. Among the hereditary tumors we usually find, the main ones are hereditary breast cancer, ovarian cancer and colorectal cancer. These cancers have relatively clear early screening and prevention measures, while many other tumors do not know how to screen and prevent even if you know that they are genetic mutations.
In addition, there are many genes that only slightly increase a person's risk of cancer. For example, this person's original risk of cancer is one in a thousand, so after genetic examination, this risk becomes two in a thousand and three in a thousand, which is only two or three times in numerical terms. However, whether it is 1/1000 or 3/1000, it is not enough for us to change our clinical decision and ask us to do early examination or prevention.
Myth 5: Pets are omnipotent.
CT examination can find lumps and tumors in the body. PETCT adds a pet device to CT. What is a pet? It reflects the active degree of tumor growth. CT plus PET can show that there is a mass in the body, and then detect whether the mass grows fast or not and whether it is metabolically inactive.
Generally speaking, the more active the metabolism, the more we suspect that it is a malignant tumor, so from the mechanism of PETCT, it seems to be a good tumor screening method. But in fact, PETCT is mostly used for clinical tumor examination to see if there is systemic metastasis, rather than for tumor screening. For example, in the screening of female cervical cancer, only some abnormal cells in the mucosal epithelium can be seen in most cases, which is a very early situation, but this can not be seen on PETCT, because it is difficult for PETCT to find tumors below 1cm, so it is not suitable for tumor screening.
Myth 6: Capsule endoscopy
In the examination of gastric cancer and intestinal cancer, we need to do endoscopic examination. Some people may have done gastroscopy, not painless gastroscopy, so there is some pain, which leads to the resistance to gastroscopy. Some people have found a better technology called capsule endoscope. Swallow a capsule with a camera in it. After swallowing, it will go from our mouth to esophagus to stomach to intestine, and we can clearly see the whole intestinal mucosa. This is the theoretical advantage of capsule endoscopy. Because the human intestine is very long, mostly small intestine, tumors in small intestine only account for less than 1% of digestive tract tumors. Most tumors are esophageal cancer, gastric cancer and colorectal cancer, so esophageal cancer and gastric cancer can be seen clearly through ordinary endoscopy, and colorectal cancer can be seen clearly through colonoscopy without capsule endoscopy.
As can be seen from the above two pictures, the left picture shows an esophagus under capsule endoscope, and the right picture shows the stomach under ordinary endoscope. It can be seen that the ordinary endoscope can see more clearly than the capsule endoscope, and all the blood vessels in the stomach can be seen. Therefore, if there is a problem with capsule endoscopy, it is still necessary to do general endoscopy for biopsy. What should capsule endoscopy be used for in clinic? Mainly used for small intestinal diseases, that is to say, a person has done a lot of tests, including gastroscopy and colonoscopy, and found no problems. At this time, the doctor suspects that the problem lies in the small intestine. At this time, it is meaningful to do capsule endoscopy.
Myth 7: Physical examination can detect all diseases.
There are tens of thousands of diseases now, and it is difficult to find all the diseases through a physical examination. What kind of disease is the physical examination for? Mainly to find out common major diseases, such as common malignant tumors, including lung cancer, breast cancer, cervical cancer, colorectal cancer (colorectal cancer), liver cancer, gastric cancer and so on. Because the early symptoms of these visceral tumors are not obvious, the symptoms are often in the middle and late stages, so regular examination is very important. In addition, common chronic diseases can also be found at an early stage, such as hypertension, diabetes, hyperlipidemia and hyperuricemia. It is helpful to intervene in these diseases.
The purpose of physical examination is also to find preventable and treatable diseases. Among the common infectious diseases, hepatitis B, hepatitis C and helicobacter pylori can all be treated. For example, although hepatitis B is difficult to cure, if a pregnant woman finds hepatitis B before pregnancy, she can use anti-HBV drugs during pregnancy, which can reduce the risk of hepatitis B spreading to her children. For another example, Helicobacter pylori is also a common pathogen causing gastric cancer, so it can be effectively eliminated by drug treatment.
Myth 8: There is no need to take preventive measures for physical examination.
Taking lung cancer as an example, lung cancer is mainly screened by CT. What effect can ct screening achieve? It can reduce the death rate of lung cancer by 20%, so even CT examination can't prevent all lung cancers, let alone find all lung cancers early. Therefore, the problems arising from physical examination are only a part of our health management, and a very important part is prevention. For example, the prevention of lung cancer is to stay away from tobacco, including second-hand smoke.
Myth 9: The conclusion of physical examination is the report.
Many people will see in the physical examination report that the elderly may have twenty or thirty kinds of abnormal conditions. Some abnormal conditions need to go to otolaryngology, while others need to go to respiratory and digestive departments. In fact, after a person's physical examination, it is necessary to find out what the abnormal situation is, and it may be necessary to hang the numbers of many departments. Therefore, the conclusions of many physical examinations are simply listed, and there is no targeted overall interpretation for the physical examiners.
Misunderstanding 10: Dental examination is unnecessary.
Most physical examinations do not include dental examinations. Of course, dental examination doesn't have to be done at the same time as physical examination, but it should be done regularly every year like physical examination, so as to find early hidden dangers. The standard practice of dental examination and cleaning is twice a year. Let's simply estimate that the cost of dental examination for ten years, including tooth cleaning, is also lower than that of a dental implant. Therefore, an article circulated in the circle of friends of dentists some time ago is called "You think we want you to wash your teeth to earn your money, and we are afraid that we can't afford treatment in the future", which is actually the truth.