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Erschienen in:
Ethics Consultation Services: The Scenario Kapitel lesen Erstes Kapitel lesen

2016 | OriginalPaper | Buchkapitel

Overdiagnosis

verfasst von : Giulia Ferretti

Erschienen in: Ethical Counselling and Medical Decision-Making in the Era of Personalised Medicine

Verlag: Springer International Publishing

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Abstract

Screenings appear to be one of the most promising approaches to tackle cancer based on the assumption that prevention and proactive management of risky lesions is the best strategy to reduce fatalities from invasive cancers. However, the opportunity of early detection implies the possibility of unwanted potentially harmful outcomes, such as false-positive results and overdiagnosis. We argue that the balance between possible benefits and harms has to be established by patients deciding whether to undergo screening. Moreover, we propose Ethical Counselling as a tool for positively coping with these questions.

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Vorheriges Kapitel Oncofertility
Fußnoten
1
Mortality refers to the number of people who died within a population and differs from morbidity, which refers to the state of being diseased or unhealthy within a population. Among the innovations that have contributed to reduce cancer mortality, we might find: chemotherapy, adjuvant therapy, combination chemotherapy, hormone therapy (for breast and prostate cancers), improvements in surgery techniques, radiation, immunotherapy (for breast cancer and lymphoma), targeted therapy (growth signals inhibitors, angiogenesis inhibitors and apoptosis-inducing drugs).
 
2
Screenings can be defined as programmes aimed at a population, no member of which is thought to be at greater risk and often indicates a heightened risk of the condition, which has to be confirmed through further diagnostic tests. By contrast (as shown in chapter “Incidental Findings”), testing refers to a procedure performed on an individual who has been identified as being at high risk and aims at confirming the tested-for condition. Examples of widespread cancer screening methods are as follows: mammography screening for breast cancer, PSA test for prostate cancer, and HPV test and PAP cytology test for cervical cancer.
 
3
For the public health debate on cancer screening see Wright and Mueller (1995), Holland (2007), Juth and Munthe (2012).
 
4
In the context of cancer screening, low-grade in situ carcinomas (the non-obligate precursor of infiltrating carcinoma) are likely to cause a number of cases where the diagnosis of malignancy is made, but the tumour may not prospectively be fatal nor clinically relevant for the patient. Although screen-detected carcinoma in situ is not a life-threatening condition, it is often treated the same way as invasive cancer due to the inability to predict with certainty on the screening images or results its further development.
 
5
The rate of overdiagnosis for different cancer types changes widely among studies. In this work, we take into account three studies: a 15 years’ follow-up after the end of the Malmö mammographic screening trial revealed a mortality reduction of 20 % and a 24 % risk of overdiagnosis; for lung cancer, a 16 years’ follow-up after the end of the Mayo trial revealed a mortality reduction of 13 % and a overdiagnosis risk of 51 %; for prostate cancer, the European Randomized Study of Prostate Cancer revealed a mortality reduction of 20 % and a overdiagnosis risk of 67 %.
 
6
The lead-time bias refers to the added time of illness produced by the diagnosis of a condition during its pre-clinical phase. The length bias is typical of cancer screening because it refers to the inclusion in survey of more slow-growing cancers with longer disease duration and better prognosis than fast-growing cancers. The healthy volunteer bias concerns screening in which the participants are healthier than the general population showing spuriously increased benefits of the intervention.
 
7
The principle of double effect (PDE) is often pleaded to justify the permissibility of an action that causes harm as side effect of promoting a good end. In medical ethics, PDE is often mentioned in discussions on palliative care, which aims at pain relief but may also cause respiratory failure. For the action being permissible, four conditions have to be verified at the same time: (i) the action’s object is good or at least indifferent; (ii) the intended effect is the good and not the evil one; (iii) the good effect is not produced by means of the evil one; (iv) there is a proportionately reason for permitting the evil effect. For more information on the PDE see McIntyre (2014).
 
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Metadaten
Titel
Overdiagnosis
verfasst von
Giulia Ferretti
Copyright-Jahr
2016
Buch
Ethical Counselling and Medical Decision-Making in the Era of Personalised Medicine

Print ISBN: 978-3-319-27688-5

Electronic ISBN: 978-3-319-27690-8

Copyright-Jahr: 2016

DOI
https://doi.org/10.1007/978-3-319-27690-8_11

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