“…2 ). Whilst overdiagnosis has been described most frequently in populations with organised cancer screening, evidence is also accumulating for drivers of overdiagnosis outside of screening and outside of cancer: widening disease definitions, recommendations to investigate for cancer at lower risk thresholds, and the incidental detection of abnormalities in patients being scanned for other reasons 21 . Figure 2 Trends in incidence and mortality for ( a ) a true increase in disease and ( b ) a disease being overdiagnosed and ( c ) overdiagnosis predominates but changes in underlying disease risk.…”
The incidence of cancer in the United Kingdom has increased significantly over the last four decades. The aim of this study was to examine trends in UK cancer incidence and mortality by cancer site and assess the potential for overdiagnosis. Using Cancer Research UK incidence and mortality data for the period (1971–2014) we estimated percentage change in incidence and mortality rates and the incidence-mortality ratio (IMR) for cancers in which incidence had increased >50%. Incidence and mortality trend plots were used to assess the potential for overdiagnosis. Incidence rates increased from 67% (uterine) to 375% (melanoma). Change in mortality rates ranged from −69% (cervical) to +239% (liver). The greatest divergences occurred in uterine (IMR = 132), prostate (IMR = 9.6), oral (IMR = 9.8) and thyroid cancer (IMR = 5.3). Only in liver cancer did mortality track incidence (IMR = 1.1). For four cancer sites; uterine, prostate, oral and thyroid, incidence and mortality trends are suggestive of overdiagnosis. Trends in melanoma and kidney cancer suggest potential overdiagnosis and an underlying increase in true risk, whereas for cervical and breast cancer, trends may also reflect improvements in treatments or earlier diagnosis. A more detailed analysis is required to fully understand these patterns.
“…2 ). Whilst overdiagnosis has been described most frequently in populations with organised cancer screening, evidence is also accumulating for drivers of overdiagnosis outside of screening and outside of cancer: widening disease definitions, recommendations to investigate for cancer at lower risk thresholds, and the incidental detection of abnormalities in patients being scanned for other reasons 21 . Figure 2 Trends in incidence and mortality for ( a ) a true increase in disease and ( b ) a disease being overdiagnosed and ( c ) overdiagnosis predominates but changes in underlying disease risk.…”
The incidence of cancer in the United Kingdom has increased significantly over the last four decades. The aim of this study was to examine trends in UK cancer incidence and mortality by cancer site and assess the potential for overdiagnosis. Using Cancer Research UK incidence and mortality data for the period (1971–2014) we estimated percentage change in incidence and mortality rates and the incidence-mortality ratio (IMR) for cancers in which incidence had increased >50%. Incidence and mortality trend plots were used to assess the potential for overdiagnosis. Incidence rates increased from 67% (uterine) to 375% (melanoma). Change in mortality rates ranged from −69% (cervical) to +239% (liver). The greatest divergences occurred in uterine (IMR = 132), prostate (IMR = 9.6), oral (IMR = 9.8) and thyroid cancer (IMR = 5.3). Only in liver cancer did mortality track incidence (IMR = 1.1). For four cancer sites; uterine, prostate, oral and thyroid, incidence and mortality trends are suggestive of overdiagnosis. Trends in melanoma and kidney cancer suggest potential overdiagnosis and an underlying increase in true risk, whereas for cervical and breast cancer, trends may also reflect improvements in treatments or earlier diagnosis. A more detailed analysis is required to fully understand these patterns.
“…Such early diagnosis initiatives were enacted amongst wider healthcare and cultural changes whereby units of measurement become imbued with moral evaluations, so that more or faster are assumed -when contrary information is unavailable -to be 'better' (Moynihan et al, 2012;Rosa, 2003). While the rationale for early diagnosis interventions was clear, the impact upon patient survival and -for this article -care now needs to be considered (Bankhead, 2017;Bastian, 2017;Nicholson, 2017). Therefore we ask how an emphasis on temporal aspects of early diagnosis are reflected in patient accounts of cancer diagnosis and care.…”
Initiatives emphasising the timeliness of diagnosis and treatment are reflected in the ways some patients experience their care. However, these accounts were open to further contextualisation about what speed of healthcare processes meant for evaluating the quality of their care. Healthcare professionals could therefore be an important patient resource in providing reassurance and support about the timeliness of diagnosis or treatment.
“…If one stop clinics encourage referral of patients who would not have been referred to standard multi-step pathways, then there is a potential risk of overdiagnosis of cancer-diagnosis of a cancer that would not have caused harm during a patient's lifetime. Overdiagnosis of cancer is most commonly described in the context of screening but it is possible to diagnose cancer in patients with symptoms from another cause, especially when lower risk patients are tested (50). Based on the findings of this review, we are unable to comment on the risk of overdiagnosis in one-stop clinics: only one study reported patients diagnosed with asymptomatic breast cancer and most also had symptomatic breast cancer (29).…”
Section: Implications For Research and Practicementioning
This review found one-stop clinics were associated with reduced time from referral to testing, increased same day diagnoses, and were acceptable to patients and GPs. Our conclusions are limited by high levels of heterogeneity, scarcity of comparator groups, and the overwhelmingly observational nature of included studies.
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