Sue Rochman is an independent health care journalist and editor based in San Francisco.
Reader’s Digest proudly touts itself as one of the most trusted media brands. But can its more than 3 million subscribers – and 19.3 million readers – trust its recommendations about which screening tests they need as they move through the decades of their lives?
There are a number of recommendations made in its recent advice article “Doctor Visits You Need to Make at Every Age” that, if followed, would have its readers asking for—and paying for—tests that they don’t need and which might do more harm than good.
Here’s how things went awry:
RD Recommendation: Women should begin clinical breast exams and pelvic exams.
Actually, no. As the American Cancer Society (ACS) explains on its website, studies have not shown that doing monthly breast self-exams or having your doctor perform a clinical breast exam will reduce your risk of dying from breast cancer. The recommendation the ACS makes, which applies to women of all ages is this: “Women should be familiar with how their breasts normally look and feel and report any changes to a health care provider right away.”
Pelvic exams are a routine aspect of most women’s healthcare. Yet whether they are necessary actually isn’t known. The most recent recommendations from the United States Preventive Services Task Force (USPSTF) explain that there is currently not enough evidence to weigh the benefits and harms of having women get this test regularly.
RD Recommendation: STD Screening
According to the article, the USPSTF says women and men in their 20s should get routine sexually transmitted disease (STD) screenings. But that’s incorrect. The recommendation is yearly testing for chlamydia and gonorrhea in women age 24 or younger who are sexually active. There’s not enough evidence to say whether or not men should also be screened. Screening for HIV should begin at 15.
RD Recommendation: Dental Exam Every 6 Months
The article gets it wrong on dental visits, too. It claims the American Dental Association says dental exams should be every six months. Their recommendation since June 2013 has been “regular dental visits, at intervals determined by a dentist.”
RD Recommendation: Discuss with Your Dermatologist
The article said the American Academy of Dermatology states that people should talk to their dermatologist about their sun exposure and if they need regular skin exams. But you’re not part of that group simply because you’ve turned 30. In reality, it’s for adults of any age with an increased risk of melanoma or who have worrisome skin lesions.
It also says the USPSTF has “yet to make a recommendation” about skin cancer screenings for the general public. That’s not quite accurate. Instead, they noted insufficient evidence to make any recommendation for screening.
Also important to keep in mind: While skin exams are at least non-invasive, they’re not risk free.
“Potential harms of skin cancer screening include misdiagnosis, overdiagnosis, and the resulting cosmetic and—more rarely—functional adverse effects resulting from biopsy and overtreatment,” the task force noted.
RD Recommendation: Eye Exams
The article explains that the American Academy of Ophthalmology recommends eye exams starting at 40, but then quotes one doctor who says they could start earlier—even though that goes against the recommendations.
RD Recommendation: Benchmark Brain Exam
There are no medical associations that recommend benchmark brain exams for anyone at any age. Yet, the article quotes a doctor who recommends getting a brain exam which could “include a magnetic resonance imaging (MRI) scan, an MR angiogram, as well as carotid ultrasonography.”
Dr. Virginia Moyer, who chaired the USPSTF from 2011 to 2014 and has extensive expertise in evidence-based medicine, found this advice baffling. “The USPSTF gives carotid ultrasound a ‘D’ rating,” she said, “so the experts actually say it’s a bad idea.” Moreover, “there is really no reason to even think this kind of ‘brain screening’ would work,” Moyer added. “There are no studies at all that support this, and a number that find it not to be effective.”
The bottom-line, said Moyer: “Getting a benchmark brain exam would lead to anxiety and unnecessarily costly and potentially dangerous invasive diagnostic procedures.”
RD Recommendation: Mammogram
The benefits and harms of mammography are widely discussed and debated. The article misrepresents the recommendation of the American College of Obstetrics and Gynecology (ACOG). It does not recommend women start getting mammograms at age 40. Recognizing that there are differing recommendations, ACOG promotes shared decision making between women and their doctors in deciding which guidelines to follow. This could mean starting mammography at 40, 45 or 50, depending on a woman’s individual risk factors.
“It’s too bad that the piece did not explicitly highlight the conflict in recommendations by ACOG vs. USPSTF,” said oncologist Andrae Vandross, MD. “This would at least allow patients to ask their physicians about the details. Mammography screening will likely continue to be controversial, but we should at least emphasize the importance of having patient-focused conversations regarding benefits and harms.”
RD Recommendation: Discuss a PSA Blood Test
PSA blood tests for prostate cancer are another area of ongoing discussion and debate. The article sidesteps and misrepresents the USPSTF recommendation, which is that it should be an individual decision—starting at age 55, not 40. It also misrepresents the American Cancer Society’s position (and doesn’t use their correct name either). The ACS recommends that men talk to their doctor about whether to be screened and if a man is at average risk and wants to have a PSA test, the first test would be at 50. Only high-risk men might start screening at 45.
RD Recommendation: Colonoscopy
The article quotes a gastroenterologist who calls colonoscopy “the most important gastrointestinal screening test for the average person.” But a colonoscopy is only one of the screening tests recommended for colorectal cancer. An annual stool-based test is also recommended by both the ACS and USPSTF, and stool testing is actually supported by stronger evidence of benefit than currently exists for colonoscopy (a point HealthNewsReview.org highlighted in this comparison of American and Canadian colon cancer screening guidelines.)
RD Recommendation: Bone Density Scan
The USPSTF recommends women have their first bone density scan at age 65, not age 50. It also concluded there was not enough evidence to determine if men would benefit from screening.
RD Recommendation: Baseline Hearing Test
In 2012, the USPSTF concluded there was not enough evidence to determine the benefits or harms of screening for hearing loss in adults age 50 and older who were not having hearing problems.
There is a widespread perception among the public and many journalists that preventive screenings can only do good and never cause harm.
But as we’ve pointed out time and again in our analysis of media messages about screening, the decision to get screened is rarely as cut-and-dried as it may seem and there are a host of potential downsides ranging from false-positive results to unnecessary and expensive treatments. This Reader’s Digest piece, which glosses over many of these harms and which repeatedly misstates who should be screened, is an example of the kind of coverage that can mislead people into bad decisions.
Reflecting on the full article, Moyer noted the irony that Reader’s Digest has published other stories that advise readers to only trust advice that has “…sound, peer-reviewed research available to support whatever claims or suggestions are being made.”
“Hmmm,” Moyers said, “Reader’s Digest not following their own warnings?”