“Preventing overdiagnosis: how to stop harming the healthy,” is a feature in this week’s BMJ by Ray Moynihan, Jenny Doust and David Henry. I won’t try to recapture the entire piece in this blog because you should read it yourself. But here are section headings: Screening detected overdiagnosis Increasingly sensitive tests Incidentalomas Excessively widened definitions (of disease) Examples of overdiagnosis Asthma—Can…
…f 50 Option 3: Do Not Recommend Screening Mammography Dr. Gil Welch, one of the authors of the “Effect of Three Decades…” analysis, wrote a New York Times opinion piece, “Cancer Survivor or Victim of Overdiagnosis?” in which he summarized: “So here is what we now know: the mortality benefit of mammography is much smaller, and the harm of overdiagnosis much larger, than has been previously recognized. But to b…
…f 50 and 70 to undergo a mammogram every three years. The current invitation letters and accompanying leaflets have been heavily criticised for failing to mention potential harms of breast screening, in particular the risk of overdiagnosis and overtreatment (http://www.bmj.com/content/338/bmj.b86). In response to this criticism, Sir Michael Richards, National Cancer Director for the NHS, asked eminent epidemiologist Sir Michael Marmot to chair an…
Gil Welch and Bill Black of Dartmouth address cancer overdiagnosis in a new review article in the Journal of the National Cancer Institute. Excerpt from the abstract: “We estimated the magnitude of overdiagnosis from randomized trials: about 25% of mammographically detected breast cancers, 50% of chest x-ray and/or sputum-detected lung cancers, and 60% of prostate-specific antigen-detected prostate cancers. We also review data from observ…
I’m in my element, among 600 or so attendees at the Association of Health Care Journalists’ annual conference in Atlanta. But, as a result, I only have time today to point you to a couple of interesting pieces: A Reuters special report on how an aggressive campaign for esophageal cancer screening feeds overdiagnosis debate. On the Washington Post’s Wonkblog, “How WebMD convinces us we’re dying.” …
… the fact that PSA level, the current biomarker, is not a sufficient basis for treatment decisions. Without the ability to distinguish indolent from aggressive cancers, lowering the biopsy threshold might increase the risk of overdiagnosis and overtreatment. Here’s a Reuters summary of the article. WebMD’s is here. Katie Hobson on the WSJ Health Blog offered good perspective. …
We’ve long been admirers of the Croakey blog, run by Melissa Sweet in Australia. Now Croakey has a new project called The Naked Doctor. The site says: Naked Doctor aims to encourage discussion and awareness of the opportunities to do more for health by doing less. It is a compilation of articles, books and other works that highlight overdiagnosis and overtreatment. It is a project of Dr Justin Coleman, a GP who works in Aboriginal and Torr…
Today must be psych day on the blog. There’s a noteworthy column in Psychiatric Times, “Normality Is an Endangered Species: Psychiatric Fads and Overdiagnosis,” by Allen Frances, MD. He was chair of the task force that worked on the Diagnostic & Statistical Manual – DSM-IV – one edition of the “bible of psychiatry.” He is professor emeritus of psychiatry at Duke University School of Medicine. The…
“I believe overdiagnosis is the biggest problem posed by modern medicine,” writes Dr. Gil Welch in his new book, “Overdiagnosed: Making People Sick In The Pursuit of Health,” which he coauthored with Drs. Lisa Schwartz and Steve Woloshin. Welch continues: “It has led millions of people to become patients unnecessarily, to be made anxious about their health, to be treated needlessly, and to bear the inconvenience …
…reening in the control group. The validity of the negative PLCO results is uncertain. The ERSPC study was more credible, but showed only a small absolute survival benefit. This benefit must be balanced against the harms of overdiagnosis–finding cancers that would never cause clinical problems during a man’s lifetime–and the resulting overtreatment, which can lead to urinary, bowel, and sexual dysfunction. Unfortunately, we c…
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