Do No Harm by Henry Marsh is a great book that gives some perspective on what it’s like to have to make these decisions. In both their success and failure.
Here’s an excerpted chapter: http://lithub.com/aneurysm/
Here’s an excerpted chapter: http://lithub.com/aneurysm/
0.05% per year chance for a person that is 32 years old leaves 50*0.05 = 2.5% chance of rupture during the remaining life of the patient, whereas the operation itself has a 5% chance of failure.
It's reminiscent of the downside of scanning for just about everything in patients without symptoms.
Now you’re talking about a possible 1% difference and the negative affect on someone’s life from the anxiety of knowing they have an aneurysm. I also wonder if the operation is less risky with a younger patient. While it may have been better to never have known you have an aneurysm, once you do know the decision isn’t obvious to me.
He did offer his opinion for himself, but being older changes the equation. In her case she did have initial symptoms that lead to the scan, but they were likely unrelated.
Paternalistic medicine isn’t really a thing anymore so on these edge cases I think it makes sense to discuss the risks with the patient (which is what was discussed at the beginning of the story).
A bit of googling will give you lots of articles on the subject, the same kind of evidence exists for prostate and other cancer screenings as well as other diseases.
It’s a detailed history of cancer and spends some time talking in detail about how statistics determine at what age preventative testing makes sense given false positive risk.
The surgeon had to do the math with her, instead of wondering, whether she understood the risks or not.
Unfortunately, many people are illiterate with numbers, so you cannot assume that in that person's head numbers like 5% and 0.05% do not both translate to "negligibly small".