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.
So, re-reading this and running the numbers it looks like a classical example of an un-necessary expensive procedure (and a risky one at that), could anybody with more medical knowledge comment on this?
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.
Well the failure is 4-5% and with increasing life expectancy she could have 60 years left (60*.05 = 3%).
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).
The downside of scanning for everything is that you'll end up increasing the cost of medicine considerably for extremely little gain. Case in point: breast cancer screenings catch a lot of malignant tumors in an early stage helping many patients before their cases become more serious. But the downside is that it has caused a large number of un-necessary procedures as well raising the costs and - and this is the kicker - blocking the available capacity with cases that would never become serious in turn denying that capacity to people whose cases are serious.
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.
For another great book related to your breast cancer example check out The Emperor of All Maladies.
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.
That's a very stupid decision to make from her side. She had small children, so every additional year she lives is immensely important for her children. To die in the next year is just 0.05% probability, to die now - 5%. Even if she dies in 10 years, these 10 years of her life would have been an unmeasurable gift to her children comparing it with her dying on the operating table.
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".
Here’s an excerpted chapter: http://lithub.com/aneurysm/