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Research Letter | Less Is More

Overdiagnosis and Overtreatment:  Evaluation of What Physicians Tell Their Patients About Screening Harms

Odette Wegwarth, PhD1; Gerd Gigerenzer, PhD1
[+] Author Affiliations
1Max Planck Institute for Human Development, Harding Center for Risk Literacy, Berlin, Germany
JAMA Intern Med. 2013;173(22):2086-2087. doi:10.1001/jamainternmed.2013.10363.
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Cancer screening can produce benefits: finding true and treatable cancer at an early stage. However, it also can produce harms by overdiagnosis and overtreatment.13 Overdiagnosis is the detection of pseudodisease—screening-detected abnormalities that meet the pathologic definition of cancer but will never progress to cause symptoms. The consequence of overdiagnosis is overtreatment—surgery, chemotherapy, or radiation—that provides the patient no benefits, but only adverse effects. For instance, for every 2000 women attending mammography screening throughout 10 years, 1 less dies of breast cancer. Concurrently, approximately 10 women with pseudodisease receive a diagnosis of breast cancer and are unnecessarily treated.4 Are patients informed about overdiagnosis by their physicians when discussing cancer screening? How much overdiagnosis would they tolerate when deciding to start or continue screening?

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Figure.
Proportion of Participants Answering the Question on Overdiagnosis

For the survey item on the number of overdiagnosed people per 1 life saved from cancer death due to screening that they would find tolerable while still being prepared to start screening, participants were able to choose from the following options: 0, up to 1, up to 5, up to 10, up to 20, up to 50, and up to 100.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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