Overdiagnosis: An epidemic or minor concern?

From the 24th January 2013 article at Medical News Today

An editorial by two oncologists in the New Year’s issue of Annals of Internal Medicine discusses overdiagnosis, a controversial health problem that some have called “a modern epidemic” but others, including the editorialists, feel is a minor concern. Although many chronic conditions are overdiagnosed, cancer is the most thoroughly studied, as well as the most emotionally charged.

I am a generally healthy man with no family history of significant health problems. Yet increasing numbers of men like me who are approaching middle age may be shadowed by a sniper on a rooftop, each armed with a highly accurate loaded rifle pointed directly at our heads. By age 70, nearly half of all men will be shadowed by a sniper, though in only 3 percent of us will he actually take the fatal shot. A 1 in 30 chance of being assassinated without warning still seems too high, and therefore health authorities concerned about the problem of snipers on rooftops recommend that all men after age 50 (or perhaps 40) be offered routine surveillance to determine if there’s a sniper up there. If there is, perhaps he can be safely disarmed.

The  trouble is, the disarmament team is successful at best, 21 percent of the time(reducing a man’s chance of being shot from 3 percent to a barely more reassuring 2.4 percent), and at worst, hardly ever. In addition, attempts to subdue snipers by force often lead to unwanted consequences: stray shots fired in the scuffle that causenon-lethal but persistent injuries to the bladder and reproductive system. In about 1 in 300 men, the attempt to disarm the sniper goes terribly wrong, causing the gunshot to miss the head but deliver an equally fatal round through the heart….

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Back to the Annals editorial about overdiagnosis in breast cancer. The authors write:

We believe that the term “overdiagnosis” in the context of breast cancer places this problem in an inappropriate light, suggesting that these patients do not have cancer. The question is not whether we should find early, more easily treatable cases of breast cancer but rather how to treat early-stage cancer found on mammography. … For the individual patient, the question is not whether to have a mammogram that might “overdiagnose” breast cancer but how to treat the early-diagnosed non-invasive or invasive breast cancer once we have found it.

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Finally, I apologize to any of you who were offended by my explicit comparison of overdiagnosis to gun violence, given the recent tragedy that has drawn belated attention to the latter as a public health problem.

 

 

Related articles

• Cancer Expert Remains To Be Convinced By Breast Screening Review (medicalnewstoday.com)
• Cancer Survivor or Victim of Overdiagnosis? (nytimes.com)
• The medical fiasco (dawn.com)

 

Related posts at this blog

• The medicalization of modern life
• More information does not equal better care
• Critics detect hype in “Bra Detects Cancer” news
• Nine (9) part series on over diagnosis
• Is preventative medicine really over treatment?