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Overdiagnosis

The detection of a condition that would not go on to cause symptoms or death, is referred to overdiagnosis.

A side effect of screening for early forms of disease.

Although screening saves lives in some cases, it may turn people into patients unnecessarily and may lead to treatments that do no good and perhaps do harm.

For a large percentage of incidental findings, the most appropriate medical response is to recognize them as something that does not require intervention.

Overdiagnosis occurs when a disease is diagnosed correctly, but the diagnosis is irrelevant.

With aggressive testing, the yield of useful information increases only slightly and some diagnostic test generate the detection of mostly incidental findings with the frequency proportional to the excess of testing performed.

A correct diagnosis may be irrelevant because treatment for the disease is not available, not needed, or not wanted.

Most people who are diagnosed are also treated, it is difficult to assess whether overdiagnosis has occurred.

Overdiagnosis cannot be determined during life.

Overdiagnosis is only certain when an individual remains untreated, never develops symptoms of the disease and dies of something else.

Rapidly rising rates of testing and disease diagnosis in the setting of stable rates of the feared outcome of the disease are highly suggestive of overdiagnosis.

A persistent excess of detected disease in screening tested group years after a trial is completed constitutes the best evidence that overdiagnosis has occurred.

The central harm of cancer screening is overdiagnosis, with detection of abnormalities that meet the pathologic definition of cancer but will never progress to cause symptoms or death during a patient’s lifetime.

Cancer screening tends to disproportionately detect slow-growing cancers and disproportionately miss the fast-growing cancers, the very cancers we would most like to catch.

But some pre-clinical cancers will not progress to cause problems for patients, and if screening detects these cancers, overdiagnosis has occurred.

Cancer screening is most useful in detecting slowly progressing cancers but can cause overdiagnosis if very slow or non-progressive cancers are detected.

If a cancer grows slowly enough, then patients will die of some other cause before the cancer gets big enough to produce symptoms:

prostate cancer in older men serves as the most prominent clinical example.

Non-progressive cancer never causes problems because it is not growing at all, and is associated with overdiagnosis.

Non-progressive cancers or very slow growing cancers are collectively referred to as pseudodisease.

Cancer overdiagnosis occurs when the criteria for cancer fulfills pathologic criteria, but does not go on to cause symptoms or death or the cancer progresses so slow.y  a patient dies of other causes prior to developing symptoms.
Cancer the diagnosis can be associated with both earlier detection and detection of slower growing tumors, over diagnosis can lead to perceived improvement in survival.

Aother definition of overdiagnosis is simply the detection of pseudodisease.

The phenomenon of overdiagnosis is most widely understood in prostate cancer.

Overdiagnosis also. has been identified in mammographic screening for breast cancer, at a 10% rate.

In other opinions, one-quarter of mammographically detected breast cancers may represent overdiagnosis.

Overdiagnosis has also been identified in chest x-ray screening for lung cancer, suggesting that 20-40% of lung cancers detected by conventional x-ray screening represent overdiagnosis.

Evidence suggests overdiagnosis is much greater for lung cancer screening using spiral-CT scans.

Overdiagnosis has also been associated with early detection of neuroblastoma, melanoma, and thyroid cancer.

Physical effects of unnecessary diagnosis and treatment include: All medical interventions that have side effects, psychological effects, and economic burden.

Overdiagnosis is often confused with the term false positive test.

False positive test result refers to a test that suggests the presence of disease, but is ultimately proved to be in error.

Patients with false positive test results are told they don’t have disease and are not treated.

Overdiagnosed patients are told they have disease and generally receive treatment.

Misdiagnosed patients do not have the condition at all, or have a totally different condition, but are treated anyway.

Misdiagnosis can result in failure to provide treatment for the patient’s actual condition, causing preventable suffering or even death.

Treatment costs for unnecessary treatment, and in cases of a different condition, failure to treat the correct condition may result in more expensive complications and more missed work days, or even permanent disability.

Overdiagnosis contributes disproportionately to early diagnosis of lethal conditions, has the effect of inflating survival statistics.

The more overdiagnosis, the better survival appears, encouraging the more testing is encouraged, leading to more overdiagnosis.

Overdiagnosis can inflate survival rates without any actual health benefits.

Patients of physicians who own imaging equipment generally receive more non-recommended imaging(Lipitor-Snyderman).

Asymptomatic bactiuria is  a missed diagnosis for urinary tract infection, and exemplifies over diagnosis.
Physicians often overdiagnose pharyngitis as being bacterial in origin, leading to overtesting and/or overtreating: 60-70% of ambulatory outpatient visits for a sore throat and with an antibiotic prescription.

 

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