Prevention is better than cure

Early detection via screening tests a necessity

Our casual attitude towards health is alarming. Not just the attitude of the individual citizen but also that of the government—leading to suffering for thousands of people that could have been prevented. This is evident from the latest World Health Organization (WHO) statistics that measure a country’s ‘health expenditure per capita’ which includes public as well as private health expenditures. It is astonishing that in the year 2015, Pakistan’s health expenditure per capita was US$ 36 which is lower than the same expenditure by Afghanistan (US$ 57), a country torn by war and political unrest. In fact, our health expenditure is also lower than the recommended US$ 44 per capita expenditure as suggested by the WHO.

Early detection of an illness helps in improving one’s chances of having a better quality of life—it can save a life. A screening test acts as a tool for early detection of diseases, which improves chances of successful treatment. Therefore, individuals should opt for regular general health check-ups to catch a potential treatable condition in time. If one talks about cancer in particular, those who fall in the high risk category, such as those who have a family history of cancer, certain chronic infections, and certain habits, need to be extra vigilant about their health. It is very easy to assume “it cannot be me”—but it can be any one of us. If you have a family history of cancer, certain gene mutations are being passed down in your family—in fact, about 10% of cancers are due to an inherited condition. If you have chronic hepatitis B infection or hepatitis C infection, you are at an increased risk of developing hepatocellular carcinoma.  If you have certain habits such as using tobacco, excessive drinking, having unsafe sex, or unprotected sun exposure, you have an increased risk of developing cancer or illnesses that may eventually lead to cancer. If you lead a sedentary lifestyle, eat unhealthy food, and do not have a healthy weight, you have an increased risk of developing certain types of cancer. Sometimes, even simply breathing the air infused with carcinogens increases one’s risk of developing cancer. Often, by the time symptoms develop and people seek a doctor, it is too late.

Different health screenings are recommended at different stages of one’s life; for example, before a pregnancy (such as screenings for sexually transmitted infections that can also be transferred from mother to baby during birth), during pregnancy, for new-born children and during childhood, for those in their twenties and thirties, for those in their forties, and finally those who are fifty years old and above. Therefore, according to one’s general physician’s recommendations, one should undergo regular screenings no matter how well one feels. The health check-ups and screenings range from dental and vision health check-ups to pap tests (help in early detection of cervical cancer), faecal occult blood tests (FOBT) (help in detection of bowel cancer), mammography (early detection of breast cancer), skin cancer check, immunisation status, cholesterol and glucose levels, and bone density tests.

It is unfortunate that we are willing to spend thousands of rupees on food in restaurants but when it comes to health check-ups, we excuse ourselves saying “it is too expensive.” But we have to make a choice. The majority of the people in this country do not even have the luxury of making this choice—they do not have thousands of rupees to spend in the first place. This is where the government should ideally step in, facilitating health screenings. But unfortunately, health is not our government’s top most priority, as indicated by the latest revealed budget for the fiscal year 2016-17.

Apart from the financial issue, another deterrent is a sense of fear; you do not want to know if something is wrong. But this fear has to be faced and a choice has to be made between a current peace of mind and a future risk of suffering—physical, emotional, and financial.

Sceptics argue that the danger of screenings lay in over-diagnosis or un-necessary treatment due to false positives. To counter this argument we need to understand the difference with a ‘screening’ test and a ‘diagnostic’ test. A screening test is used to detect certain disease indicators in seemingly healthy individuals. On the other hand, a diagnostic test is used to establish presence or absence of a disease after there is some indication of a possibility of a disease in an individual. No one is suggesting begin a treatment just on the basis of screenings; in case there is a hint of disease presence, it has to be confirmed via further diagnostic tests and hence, the danger of over-diagnosis is avoided. In the end, it is important you make an informed decision whether to go for a screening or not after carefully doing the cost-benefit analysis; the most profound benefit being early detection.

If you are the kind of person who has never stepped inside a hospital, you are blessed. But you need to establish a benchmark to asses if your health status is going in the right direction. And to begin with, regardless of your age, you should undergo an initial comprehensive health check-up. Then you may follow the frequency of the check-ups as recommended by your physician based on this initial test. In Lahore, The Shaukat Khanum Memorial Cancer Hospital & Research Centre offers a Comprehensive Health Care Clinic (CHCC) which guarantees state-of-the-art diagnostic facilities and gives individuals an opportunity to get an overview of their current health status. There may be other hospitals offering comprehensive health check-ups near your location. In the end, whichever quality institute you choose, it is important that you do make this choice keeping in mind that prevention is better than cure. The screening decision is not just for your sake but also for the sake of your children and future generations.