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Research Letter
Less Is More
December 9/23, 2013

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

Author Affiliations
  • 1Max Planck Institute for Human Development, Harding Center for Risk Literacy, Berlin, Germany
JAMA Intern Med. 2013;173(22):2086-2088. doi:10.1001/jamainternmed.2013.10363

Cancer screening can produce benefits: finding true and treatable cancer at an early stage. However, it also can produce harms by overdiagnosis and overtreatment.1-3 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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