Overdiagnosis – Less is More

What is meant by overdiagnosis ? Overdiagnosis is the detection of harmless abnormalities in your body during a medical examination , which would not have caused any distress if you didn’t know they existed. Such detected abnormalities wouldn’t progress or would only progress very slowly and, thus, usually do not cause symptoms or harm during a person’s remaining lifetime. Most of those abnormalities resolve spontaneously, regardless of detection. In other words, this diagnosis is unnecessary and may even be deleterious .

What doesn’t overdiagnosis mean? It is important to know that overdiagnosis is not a false -positive result or a misdiagnosis. Misdiagnosis is a wrong diagnosis – for instance, if someone is diagnosed with cancer but actually only as a benign cyst. Overdiagnosis rather reflects an “accurate” but unhelpful medical diagnosis. It is also not a false alarm. False alarms are abnormal but usually harmless findings , observed in a cloudy x-ray for example, which in further tests are disproven.

Why does overdiagnosis occur? Because of improved high-resolution diagnostic techniques. As an example: Pulmonary emboli usually do not require any treatment, and without high-resolution CT angiography they wouldn’t be detected. Here, the risk of overdiagnosis increases because of improved high-resolution diagnostic techniques.

How about an example for overdiagnosis? Let’s take the story of Ms. Miller as an example: She develops breast cancer at the age of 69, but she doesn’t experience any symptoms because her tumor grows very slowly. When she died of an unrelated heart attack at the age of 79, Ms. Miller was happily unaware that she had carried a non-dangerous cancer for about a decade. If she had been screened for breast cancer at 69 she would have been diagnosed with cancer and possibly undergone surgery, radiotherapy and years of emotional stress and possibly a reduced quality of life. But the diagnosis would not have lead to any benefit, let alone made up for her distress. That’s what overdiagnosis means. And the indicated treatment is called overtreatment . It was neither necessary nor did it improve the health of Ms. Miller.

What are the consequences of overdiagnosis? If you order more and more sophisticated tests, it is more likely that your physician diagnoses a “disease”, which poses no actual threat. From here on, overdiagnosis may become a problem, because it is not easy to discern which abnormalities are likely to progress into real diseases during your lifetime . Your doctor is to required to inform you about the findings and all possible consequences to then allow you as patient to decide whether or not to treat the observed abnormality.

Overdiagnosis often induces overtreatment. Furthermore, overtreatment may occur without overdiagnosis. For example, sinusitis and bronchitis in adults are often correctly diagnosed but overtreated with ineffective antibiotics.

There are some reports of women whose mammography suggested pathology and who were treated with mastectomy. How-ever, the removed tissue actually showed no malignancy. Those women were not overdiagnosed, but were overtreated. Therefore, some overdiagnoses or overtreatments may be more harmful to a patient than if he or she had never been diagnosed.

How can you make your own decision about screening? What should you do? Isn’t cancer always dangerous? Don’t we have to go to all screenings? Should you stop seeing a doctor? No, of course not.

We now know how different kinds of cancer behave differently, but no one can 100% predict whether or how a tumor will progress. All tumors start out small and go unnoticed at first. Some grow faster and later become life-threatening. Discovering this kind of tumor at an early stage can save your life. Others hardly grow at all and never cause any problems. Discovering those is called overdiagnosis.

Screening may improve your chances of maintaining your health. But it can also be harmful. So what can you do? Choose the option that best suits you:

Would you rather have regular screening tests even if that means risking overdiagnosis, with all the physical and psychological consequences?

Would you prefer to avoid unnecessary diagnosis and treatments, even if that means that a serious illness might only be discovered at a later stage when treatment may be less effective?

Most people find it very hard to make this kind of decision. List your own pros and cons and consider them carefully. Take your age, your fitness, your personal/family health histories, and your lifestyle into account. Then consult your physician and openly discuss your list of necessary and nonessential screening tests.

EXERCISE: 1. If tumors hardly grow, don’t cause any problems and are discovered through screening. You call it …

a. misdiagnosis b. false diagnose c. overdiagnosis

2. Overdiagnosis often includes false-positive results

a. True b. False

You’ll find the answer on: http://tinyurl.com/weiterbildung-englisch

BIBLIOGRAPHY 1. Welch G: Less Medicine, More Health: 7 Assumptions that drive too much medical care, Beacon Press 2016. 2. www.dict.cc. 3. http://dict.leo.org. 4. www.webster-dictionary.org.

CARMEN LOBITZ Carmen Lobitz ist freie Trainerin, Lehrerin und MTA. Sie gründete 1998 in Berlin lobitz seminare, die unter anderem Englischseminare für Health Professionals anbieten. Kontakt: mail@lobitz-seminare.de www.lobitz-seminare.de

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Lösung für Exercise: Answer: 1. c Answer: 2. b

Overdiagnosis – Less is More

What is meant by overdiagnosis?

What doesn’t overdiagnosis mean?

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Overdiagnosis – Less is More

What is meant by overdiagnosis?

What doesn’t overdiagnosis mean?

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