Over-Testing, False Positives and Incidental Findings in Integrative Care

Tests can be very useful when they answer a clear question. This page is about tests ordered without one, which can lead to worry, more tests and more products. It is information only. Never ignore a result your doctor tells you needs follow-up.

Key terms

A false positive is a result that suggests a problem when there is none. The National Cancer Institute (NCI) says a false-positive screening result can cause anxiety and is usually followed by more tests and procedures, which also have risks. [1] An incidental finding is something unexpected found while looking for something else, such as on a scan. Overdiagnosis and overtreatment are listed by the NCI among possible harms of screening, along with false results. [1]

What research shows about testing people without symptoms

One systematic review looked at whole-body MRI in healthy adults. This is a scan sometimes sold for prevention, and it is a different setting from blood or stool panels, but it shows the principle. The review pooled 12 studies of 5,373 people without known disease. [2]

The authors concluded that incidental findings in people without symptoms are substantial and that verification data are lacking. [2] Evidence label: mixed, with very wide variation between studies.

Some screening is helpful. The NCI says mammograms and sigmoidoscopy and fecal occult blood testing have been shown to find cancers early and decrease the chance of dying from those cancers. [1] It also says that for some cancers, finding and treating early does not improve cure or survival. [1] The question is whether a given test has been shown to help people like you.

Tests sold in integrative and alternative settings

Each of these has its own page; here is the pattern.

• Food IgG panels. CSACI says no body of research supports using food IgG tests to diagnose or predict adverse reactions to food, and that IgG to food appears to be a marker of exposure and tolerance. [3] The NHS says home food-intolerance tests have limited evidence of accuracy and may suggest avoiding multiple foods, which can be harmful. [4] See food IgG tests.
• Home metal test kits promoted with chelation products. The FDA says such kits are not cleared by the FDA and may give false or misleading results. [5] See provoked urine heavy-metal tests.
• Other panels such as hair mineral, saliva cortisol and stool microbiome tests are checked on tests sold in integrative practice.

Why medicine has a "choosing wisely" movement

The Choosing Wisely campaign began in 2012 with nine US specialty societies offering 45 examples of commonly used tests or treatments that lacked strong supporting evidence. Its goal was to spark conversations between clinicians and patients about which tests are needed and which are not. [6] This applies in every kind of clinic.

Questions to ask before a test

• What decision will this result change?
• What happens if the result is abnormal, and what follow-up tests would that lead to?
• Is this test recommended by a medical society or guideline for my situation? Can you show me?
• Does anyone selling the test also sell the products it recommends?
• Can I share the result with my own doctor?

The NCI says your provider should talk with you about the possible benefits, harms and unknowns of a screening test, including false results and overdiagnosis. [1] More on lab tests ordered in integrative practice and false positives, multiple testing and incidental findings.