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Connecting philosophy of medicine with feminist bioethics
Published in Wendy A. Rogers, Jackie Leach Scully, Stacy M. Carter, Vikki A. Entwistle, Catherine Mills, The Routledge Handbook of Feminist Bioethics, 2022
Hofmann’s own interest is in the relationships among what he calls the “triad” of sickness, illness and disease. While all parts of the triad generally occur together, he discusses a number of cases in which the three concepts come apart, that is, one or two of these phenomena occur, but not all three. For example, medically unexplained symptoms, including some kinds of chronic pain, are cases where there is illness and sickness, but no (known) disease. Overdiagnosis occurs when a condition is diagnosed that, if left untreated, would not cause the individual harm. It involves both disease (e.g. very small papillary thyroid cancer) and sickness (e.g. treatment, as well as further diagnostic and monitoring procedures), but no illness.
Where Does All This Leave Us?
Published in Peter Tate, Francesca Frame, Bedside Matters, 2020
This leads into the increasing tendency to overdiagnosis, and the creation of pseudo-disease. Medicine's ability to diagnose is outpacing our understanding of prognosis, such as finding small tumours, aneurysms and multiple ill-defined risk factors for disease. The trouble is that not all tumours grow, most aneurysms do not burst and most risk factors only occasionally lead to illness. As an editorial in the BMJ (British Medical Journal) of September 2018 says:Ironically, even though it causes harm, the effects of overdiagnosis look like benefits. People with disease that is overdiagnosed do well because, by definition, their disease was non-progressive. They are ‘cured’ when the cure was not necessary in the first place. This creates a cycle that reinforces efforts leading to more overdiagnosis.A screening test that results in substantial overdiagnosis improves survival statistics by diluting the diagnosed pool with many non-progressive cases, which makes screening seem more effective than it is. The spurious rise in incidence makes the case for screening more compelling, thus heightening people's sense of risk – a phenomenon known as the popularity paradox.
Breast cancer
Published in Anju Sahdev, Sarah J. Vinnicombe, Husband & Reznek's Imaging in Oncology, 2020
Sarah J Vinnicombe, Alexandra Athanasiou
Overdiagnosis occurs when a cancer is diagnosed which would have caused no harm during life if undetected. Published rates differ widely according to statistical methodology. A 2012 independent review concluded that four women were overdiagnosed for every life saved (41). The Euroscreen Working Group estimates a rate of 6.5% (1%–10%) (42). DCIS is problematical, as it is not clear which DCIS will progress and which will not. The UK phase III LORIS trial is randomizing women with low-risk, screen-detected DCIS to surgery or active monitoring (43). This and other similar trials will provide insight into which lesions actually require treatment.
Lipid profile screening and ASCVD prevention
Published in Expert Review of Cardiovascular Therapy, 2023
Filippo Figorilli, Massimo Raffaele Mannarino, Amirhossein Sahebkar, Matteo Pirro
Recommendation for any screening program requires assessment of the benefit-to-harm balance [17]. Although lipid profile assessment is rapid, safe, and cost-effective, it is still necessary to consider the potential harms of implementing a screening program in a specific patient population. The risk of overdiagnosis may occur, that is, the possibility of erroneously defining situations as pathological, with the potential of exposing patients to unnecessary and potentially harmful procedures and treatments. This risk may be particularly evident in multifactorial dyslipidemias, in which the evolution of the disorder from the childhood to the adulthood is less predictable. Systematic screening in childhood and young adults at low ASCVD risk could expose an otherwise healthy population to the potential side effects of an inappropriate treatment and follow-up, as well as the risk of developing negative psychological effects on patients or families.
Overview and recent advances in incidental meningioma
Published in Expert Review of Anticancer Therapy, 2023
Olivia Näslund, Per Sveino Strand, Thomas Skoglund, Ole Solheim, Asgeir S. Jakola
More is known of natural history and growth dynamics of incidental meningiomas. However, one must consider the risk of overdiagnosis and too much follow-up. Are we at risk of following benign brain tumors more closely and longer than many cancers? It is important to remember that most meningiomas have a benign disease trajectory, especially those found en passant. One early reevaluation is reasonable 6–12 months after detection, to rule out an unusual rapid growth pattern. If dural metastases could be a differential diagnosis (e.g. underlying cancer, no dural tail, inhomogenous enhancement), earlier reevaluation is advised. Based on available literature, a more active follow-up routine beyond the first scan is justified for patients harboring unusually rapid growth, T2-hyperintense tumors, larger tumors, or in tumors with peritumoral edema. As treatment of non-symptomatic meningioma is not clearly less risky than treating their symptomatic counterparts, and as symptoms due to mass effect often are reversible after surgery, and as many incidental meningiomas will never cause symptoms despite the potential to grow, one may perhaps question the need for monitoring growth in most asymptomatic meningioma patients.
The Risk of overdiagnosis and overtreatment in spondyloarthritis
Published in Scandinavian Journal of Rheumatology, 2022
A Ortolan, M Lorenzin, A Doria, R Ramonda
The risk of overdiagnosis of axial spondyloarthritis (axSpA) is a very recent concept, rarely debated in rheumatology, and understandably so, after decades of delayed diagnosis and restricted therapeutic options (1). Nowadays, in axSpA, we aim for an early diagnosis to establish an appropriate treatment and to prevent disease progression. However, a higher sensitivity should not come at the cost of specificity: a wrong diagnosis of axSpA can lead to an unnecessary burden in terms of psychological anxiety for the patient, healthcare costs, and, most of all, overtreatment. The latter is particularly dangerous to the patient, who could experience side effects of unnecessary drugs while gaining no benefit from the treatment. According to our experience, overdiagnosis is often due to a lack of consideration of alternative diagnoses or conditions. We hereby present the case of a 61-year-old woman misdiagnosed with ankylosing spondylitis (AS).