A definition and ethical evaluation of overdiagnosis

Carter, Stacy M; Degeling, Chris; Doust, Jenny; Barratt, Alexandra

doi:10.1136/medethics-2015-102928

Cited by 58 publications

(75 citation statements)

References 42 publications

(50 reference statements)

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“…Cancer overdiagnosis, in contrast, occurs when cancers are correctly diagnosed but those cancers would not have produced symptoms or been identified clinically. 6,7 It is very difficult to determine whether a particular individual has been overdiagnosed 8 , particularly in cancer screening, because once a person has been diagnosed with cancer and treated, no-one can know what would have happened without that treatment.…”

Section: Defining Overdiagnosismentioning

confidence: 99%

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What is overdiagnosis and why should we take it seriously in cancer screening?

Carter¹,

Barratt²

2017

Public Health Res Pract

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Overdiagnosis occurs in a population when conditions are diagnosed correctly but the diagnosis produces an unfavourable balance between benefits and harms. In cancer screening, overdiagnosed cancers are those that did not need to be found because they would not have produced symptoms or led to premature death. These overdiagnosed cancers can be distinguished from false positives, which occur when an initial screening test suggests that a person is at high risk but follow-up testing shows them to be at normal risk. The cancers most likely to be overdiagnosed through screening are those of the prostate, thyroid, breast and lung. Overdiagnosis in cancer screening arises largely from the paradoxical problem that screening is most likely to find the slow-growing or dormant cancers that are least likely to harm us, and less likely to find the aggressive, fast-growing cancers that cause cancer mortality. This central paradox has become clearer over recent decades. The more overdiagnosis is produced by a screening program, the less likely the program is to serve its ultimate goal of reducing illness and premature death from cancer. Thus, it is vital that health professionals and researchers continue an open, scientific inquiry into the extent and consequences of overdiagnosis, and devise appropriate responses to it.

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Section: Defining Overdiagnosismentioning

confidence: 99%

“…8 Typically, a screening program that produces overdiagnosis in a population will greatly increase the incidence of early-stage cancer or pre-cancer, without reducing the incidence of late-stage cancer or mortality from that cancer. This is illustrated in Figure 1, using the example of thyroid cancer.…”

Section: Defining Overdiagnosismentioning

confidence: 99%

What is overdiagnosis and why should we take it seriously in cancer screening?

Carter¹,

Barratt²

2017

Public Health Res Pract

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“…Dünyanın pek çok bölgesinde dördüncül koruma ile ilgili P4 ağları kurulmuştur. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19] Marc Jamoulle dördüncül korumayı anlattığı makalelerinde dördüncül korumanın "ilişkiye dayalı tıb-bı anlama" hakkında olduğunu, bu ilişkinin hastaların ve hekimlerin otonomilerine saygılı bir şekilde doğru olarak tedavi edici kalması gerektiğini bildirmektedir. [16][17][18][19][20][21] Dördüncül koruma kavramının, hasta ve hekimin bakış açısını birleştiren, "ilişkiye dayalı koruma" kavramını ayrıntılandıran yeni bir strateji sunduğunu ileri süren Jamoulle makalelerinde ilişki ve hastalıklardan koruma bağlamında hasta hekim karşılaşmasının ve koruma düzeylerinin 4 alanını tanımlamıştır.…”

Section: Introductionunclassified

“…[35] Günü-müzde diğer uzmanlık alanları da dördüncül koruma kavramı ile tanışmakta ve bazı uzmanlıklardan yazarlar dördüncül korumayı kendi alanlarına uyguladıkları makaleler yayınlamaktadır. [12,23,33] Bu makalelerde aşırı tanı ve tedaviden kaçınma vurgulanmaktadır. 'Aşırı tanı', tanı konulan durumun halen zararlı bir hastalık olmadığı ya da hastanın yaşamı süresinde zararlı hastalığa ilerlemeyeceği için yanlış kabul edilen bir tanıyı ifade etmek için kullanılan bir terimdir.…”

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“…Aşırı tanı konulmuş hasta tanı ve tedaviden yararlanmaz, ama zarar görebilir. [12,13] Endokrinolojide dördüncül korumanın kullanıldığı iki alan bildirilmiştir. Tiroid hastalıkları alanında tiroid tümörlerinin aşırı tanısından kaçınma [23] ve diyabet bakımında hastaya zarar verebilecek aşırı ya da hatalı yönetimlerin önlenmesinin [36] dördüncül koruma ile mümkün olabileceği bildirilmektedir.…”

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Quaternary prevention: First, do not harm

Kavukçu¹,

Akdeniz²

2017

tahd

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Avoiding Psychiatric Disability Overdiagnosis, Part 3: Iatrogenesis in Diagnosing Mental Health Work Disability—The Need for Implementing a Comprehensive Psychiatric Work Disability Assessment

Gagnon¹,

Kertay²

2022

AMA Guides® Newsletter

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Claims of occupational psychiatric disability have significantly increased over the past 20 years. This article is the third in a series on avoiding psychiatric disability overdiagnosis. The first article focused on general disability issues and their effects and defined basic terms and models. The second article focused on improving the diagnosis and assessment of mental health disorders and psychiatric work disability. In this final article, we focus on iatrogenesis in diagnosing mental health work disability and argue for implementing a comprehensive disability assessment approach.

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A definition and ethical evaluation of overdiagnosis

Cited by 58 publications

References 42 publications

What is overdiagnosis and why should we take it seriously in cancer screening?

What is overdiagnosis and why should we take it seriously in cancer screening?

Quaternary prevention: First, do not harm

Avoiding Psychiatric Disability Overdiagnosis, Part 3: Iatrogenesis in Diagnosing Mental Health Work Disability—The Need for Implementing a Comprehensive Psychiatric Work Disability Assessment

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