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Hsin-Hung C, En-Kuei T, Yun-Ju W, Fu-Zong W. Impact of annual trend volume of low-dose computed tomography for lung cancer screening on overdiagnosis, overmanagement, and gender disparities. Cancer Imaging 2024; 24:73. [PMID: 38867342 PMCID: PMC11170916 DOI: 10.1186/s40644-024-00716-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 06/05/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND With the increasing prevalence of nonsmoking-related lung cancer in Asia, Asian countries have increasingly adopted low-dose computed tomography (LDCT) for lung cancer screening, particularly in private screening programs. This study examined how annual LDCT volume affects lung cancer stage distribution, overdiagnosis, and gender disparities using a hospital-based lung cancer database. METHODS This study analyzed the annual utilized LDCT volume, clinical characteristics of lung cancer, stage shift distribution, and potential overdiagnosis. At the individual level, this study also investigated the relationship between stage 0 lung cancer (potential strict definition regarding overdiagnosis) and the clinical characteristics of lung cancer. RESULTS This study reviewed the annual trend of 4971 confirmed lung cancer cases from 2008 to 2021 and conducted a link analysis with an LDCT imaging examination database over these years. As the volume of lung cancer screenings has increased over the years, the number and proportion of stage 0 lung cancers have increased proportionally. Our study revealed that the incidence of stage 0 lung cancer increased with increasing LDCT scan volume, particularly during the peak growth period from 2017 to 2020. Conversely, stage 4 lung cancer cases remained consistent across different time intervals. Furthermore, the increase in the lung cancer screening volume had a more pronounced effect on the increase in stage 0 lung cancer cases among females than it had among males. The estimated potential for overdiagnosis brought about by the screening process, compared to non-participating individuals, ranged from an odds ratio of 7.617 to one of 17.114. Both strict and lenient definitions of overdiagnosis (evaluating cases of stage 0 lung cancer and stages 0 to 1 lung cancer) were employed. CONCLUSIONS These results provide population-level evidence of potential lung cancer overdiagnosis in the Taiwanese population due to the growing use of LDCT screening, particularly concerning the strict definition of stage 0 lung cancer. The impact was greater in the female population than in the male population, especially among females younger than 40 years. To improve lung cancer screening in Asian populations, creating risk-based prediction models for smokers and nonsmokers, along with gender-specific strategies, is vital for ensuring survival benefits and minimizing overdiagnosis.
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Affiliation(s)
- Chen Hsin-Hung
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, 813414, Taiwan
| | - Tang En-Kuei
- Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, 813414, Taiwan
| | - Wu Yun-Ju
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Wu Fu-Zong
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
- Faculty of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Rich NE, Singal AG. Overdiagnosis of hepatocellular carcinoma: Prevented by guidelines? Hepatology 2022; 75:740-753. [PMID: 34923659 PMCID: PMC8844206 DOI: 10.1002/hep.32284] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 11/27/2021] [Accepted: 12/04/2021] [Indexed: 12/13/2022]
Abstract
Overdiagnosis refers to detection of disease that would not otherwise become clinically apparent during a patient's lifetime. Overdiagnosis is common and has been reported for several cancer types, although there are few studies describing its prevalence in HCC surveillance programs. Overdiagnosis can have serious negative consequences including overtreatment and associated complications, financial toxicity, and psychological harms related to being labeled with a cancer diagnosis. Overdiagnosis can occur for several different reasons including inaccurate diagnostic criteria, detection of premalignant or very early malignant lesions, detection of indolent tumors, and competing risks of mortality. The risk of overdiagnosis is partly mitigated, albeit not eliminated, by several guideline recommendations, including definitions for the at-risk population in whom surveillance should be performed, surveillance modalities, surveillance interval, recall procedures, and HCC diagnostic criteria. Continued research is needed to further characterize the burden and trends of overdiagnosis as well as identify strategies to reduce overdiagnosis in the future.
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Affiliation(s)
- Nicole E Rich
- Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Amit G Singal
- Division of Digestive and Liver Diseases, UT Southwestern Medical Center, Dallas, Texas, USA
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Koo HJ, Choi CM, Park S, Lee HN, Oh DK, Ji WJ, Kim S, Kim MY. Chest radiography surveillance for lung cancer: Results from a National Health Insurance database in South Korea. Lung Cancer 2018; 128:120-126. [PMID: 30642443 DOI: 10.1016/j.lungcan.2018.12.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 10/22/2018] [Accepted: 12/25/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND Lung cancer screening with low-dose computed tomography reduced mortality in selected high risk patients. However, the use of chest radiography for lung cancer screening in Asian populations is still controversial. We investigated the effectiveness of chest radiographic surveillance using a nationwide health service data in South Korea. METHODS Data from the Korean National Health Insurance Service examinee cohort of 2004 to 2013 were examined, and 63,228 patients with lung cancer were identified, 38,494 (57%) of whom underwent chest radiography screening. The others did not undergo lung cancer screening and were considered as a control group. Clinical data including age, smoking, screening intervals, lung cancer stages, treatments, and survival were collected. Survival gain from surveillance after adjustment for lead-time bias based on the sojourn time was calculated. Cox-proportional hazard analyses were performed to evaluate the effectiveness of screening and to determine the appropriate screening interval for chest radiography surveillance. RESULTS Early lung cancer was found in 38% of patients receiving chest radiography versus 26% of those without surveillance. A patient age of more than 65 years (hazard ratio [HR], 1.53; 95% confidence limits [CL], 1.50-1.56), male (HR, 1.66; 95% CL, 1.62-1.70), and high lung cancer stages at the time of diagnosis were independent factors associated with mortality (each, P < 0.001). Chest radiography surveillance was a factor for decreasing mortality in female (HR, 0.81; 95% CL, 0.77-0.84, P < 0.001), with mortality reduction of 10% at the 3- and 5-year survival time-points. In female patients, chest radiography surveillance at intervals of less than 3 years was an independent predictor of improved survival. CONCLUSIONS Surveillance chest radiography increased survival in a female screened population in South Korea. Chest radiography intervals of less than 3 years may help to detect lung cancer in female patients.
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Affiliation(s)
- Hyun Jung Koo
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, Seoul, Republic of Korea
| | - Chang-Min Choi
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, Seoul, Republic of Korea; Department of Oncology, Asan Medical Center, Seoul, Republic of Korea
| | - Sojung Park
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, Seoul, Republic of Korea; Department of Pulmonary and Critical Care Medicine, Hallym University Dongtan Sacred Heart Hospital, Dongtan, Republic of Korea
| | - Han Na Lee
- Department of Radiology, Kyung Hee University Hospital at Gangdong, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Dong Kyu Oh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Won-Jun Ji
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Seulgi Kim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Mi Young Kim
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, Seoul, Republic of Korea.
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The Use of International Classification of Diseases Codes to Identify Patients with Pancreatitis: A Systematic Review and Meta-analysis of Diagnostic Accuracy Studies. Clin Transl Gastroenterol 2018; 9:191. [PMID: 30287807 PMCID: PMC6172207 DOI: 10.1038/s41424-018-0060-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 09/06/2018] [Indexed: 02/06/2023] Open
Abstract
Background Hospital discharge codes are increasingly used in gastroenterology research, but their accuracy in the setting of acute pancreatitis (AP) and chronic pancreatitis (CP), one of the most frequent digestive diseases, has never been assessed systematically. The aim was to conduct a systematic literature review and determine accuracy of diagnostic codes for AP and CP, as well as the effect of covariates. Methods Three databases (Pubmed, EMBASE and Scopus) were searched by two independent reviewers for relevant studies that used International Classification of Disease (ICD) codes. Summary estimates of sensitivity, specificity and positive predictive value were obtained from bivariate random-effects regression models. Sensitivity and subgroup analyses according to recurrence of AP and age of the study population were performed. Results A total of 24 cohorts encompassing 18,106 patients were included. The pooled estimates of sensitivity and specificity of ICD codes for AP were 0.85 and 0.96, respectively. The pooled estimates of sensitivity and specificity of ICD codes for CP were 0.75 and 0.94, respectively. The positive predictive value of ICD codes was 0.71 for either AP or CP. It increased to 0.78 when applied to incident episode of AP only. The positive predictive value decreased to 0.68 when the ICD codes were applied to paediatric patients. Conclusion Nearly three out of ten patients are misidentified as having either AP or CP with the indiscriminate use of ICD codes. Limiting the use of ICD codes to adult patients with incident episode of AP may improve identification of patients with pancreatitis in administrative databases.
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Hofmann B. Getting personal on overdiagnosis: On defining overdiagnosis from the perspective of the individual person. J Eval Clin Pract 2018; 24:983-987. [PMID: 30066394 DOI: 10.1111/jep.13005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 06/26/2018] [Accepted: 07/02/2018] [Indexed: 12/26/2022]
Abstract
How can overdiagnosis be defined, explained, and estimated on an individual level? The answers to this question are essential for persons to be able to make informed choices and give valid consents for tests. Traditional conceptions of overdiagnosis tend to depend on counterfactual thinking and prophetic abilities as you would have to know what would happen in the future if you did not test now. To avoid this, overdiagnosis can be defined in terms of the chance of diagnosing a person with a disease when this does not avoid or reduce manifest disease. To be able to relate this to 1's own life and deliberation, I argue that we need answers to specific questions such as the following: If I am tested, and the test and subsequent test results are positive, but I am not treated, what is the chance that I would not experience and suffer from manifest disease? A definition of overdiagnosis that aims at providing answers to this question is as follows: Prospectively overdiagnosis (of an individual person) is given by the estimated chance that a person having a positive test result would not experience and suffer from manifest disease if not treated or followed up in any way. Getting personal on overdiagnosis directs the attention of overdiagnosis estimates towards what matters in medicine: the experience of individual persons.
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Affiliation(s)
- Bjørn Hofmann
- Institute for the Health Sciences, Norwegian University of Science and Technology (NTNU), Gjøvik, Norway.,Centre of Medical Ethics, University of Oslo, Oslo, Norway
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Davies L, Petitti DB, Martin L, Woo M, Lin JS. Defining, Estimating, and Communicating Overdiagnosis in Cancer Screening. Ann Intern Med 2018; 169:36-43. [PMID: 29946705 DOI: 10.7326/m18-0694] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The toll of inadequate health care is well-substantiated, but recognition is mounting that "too much" is also possible. Overdiagnosis represents one harm of too much medicine, but the concept can be confusing: It is often conflated with related harms (such as overtreatment, misclassification, false-positive results, and overdetection) and is difficult to measure because it cannot be directly observed. Because the U.S. Preventive Services Task Force (USPSTF) issues screening recommendations aimed largely at healthy persons, it has a particular interest in understanding harms related to screening, especially but not limited to overdiagnosis. In support of the USPSTF, the authors summarize the knowledge and provide guidance on defining, estimating, and communicating overdiagnosis in cancer screening. To improve consistency, thinking, and reporting about overdiagnosis, they suggest a specific definition. The authors articulate how variation in estimates of overdiagnosis can arise, identify approaches to estimating overdiagnosis, and describe best practices for communicating the potential for harm due to overdiagnosis.
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Affiliation(s)
- Louise Davies
- The VA Outcomes Group, White River Junction Veterans Affairs Medical Center, White River Junction, Vermont, and Geisel School of Medicine at Dartmouth and Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire (L.D.)
| | - Diana B Petitti
- University of Arizona College of Medicine-Phoenix, Phoenix, Arizona (D.B.P.)
| | - Lynn Martin
- Abt Associates, Cambridge, Massachusetts (L.M., M.W.)
| | - Meghan Woo
- Abt Associates, Cambridge, Massachusetts (L.M., M.W.)
| | - Jennifer S Lin
- Kaiser Permanente Research Affiliates Evidence-based Practice Center, Kaiser Permanente Center for Health Research, Portland, Oregon (J.S.L.)
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Yamashita S, Suzuki S, Suzuki S, Shimura H, Saenko V. Lessons from Fukushima: Latest Findings of Thyroid Cancer After the Fukushima Nuclear Power Plant Accident. Thyroid 2018; 28:11-22. [PMID: 28954584 PMCID: PMC5770131 DOI: 10.1089/thy.2017.0283] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The increase in risk for late-onset thyroid cancer due to radiation exposure is a potential health effect after a nuclear power plant accident mainly due to the release of radioiodine in fallout. The risk is particularly elevated in those exposed during infancy and adolescence. To estimate the possibility and extent of thyroid cancer occurrence after exposure, it is of utmost importance to collect and analyze epidemiological information providing the basis for evaluation of radiation risk, and to consider radiobiology and molecular genetics. In this regard, the dose-response of cancer risk, temporal changes in the rates of thyroid cancer, its histopathological types and subtypes, and frequency of underlying genetic abnormalities are important. At present, however, it is difficult or impossible to distinguish radiation-induced thyroid cancer from spontaneous/sporadic thyroid cancer because molecular radiation signatures, biomarkers of radiation exposure, or genetic factors specific to radiation-induced cancer have not yet been identified. The large-scale ultrasound screening in Fukushima Prefecture of Japan demonstrated a high detection rate of thyroid cancer in young individuals, revealing 116 and 71 cases in the first and second rounds, respectively, among the same cohort of approximately 300,000 subjects. These findings raised concerns among residents and the public that it might be due to putative exposure to radiation from the accident at Fukushima Daiichi Nuclear Power Plant. This review summarizes evaluations by international organizations and reviews scientific publications by the authors and others on childhood thyroid cancer, especially those relevant to radiation, including basic studies on molecular mechanisms of thyroid carcinogenesis. Clinical details are also provided on surgical cases in Fukushima Prefecture, and the effect of thyroid ultrasound screening is discussed. Correct understanding of issues relating to radiation and the thyroid are essential for interpretation of thyroid cancer in Fukushima.
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Affiliation(s)
- Shunichi Yamashita
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan
- Department of Radiation Medical Sciences, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan
- Department of Radiation Molecular Epidemiology, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan
| | - Shinichi Suzuki
- Department of Thyroid and Endocrinology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Satoru Suzuki
- Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University, Fukushima, Japan
| | - Hiroki Shimura
- Department of Laboratory Medicine, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Vladimir Saenko
- Department of Radiation Molecular Epidemiology, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki, Japan
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Lee HS, Kang Y, Tae K, Bae GU, Park JY, Cho YH, Yang M. Proteomic Biomarkers for Bisphenol A-Early Exposure and Women's Thyroid Cancer. Cancer Res Treat 2018; 50:111-117. [PMID: 28279065 PMCID: PMC5784619 DOI: 10.4143/crt.2017.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 03/02/2017] [Indexed: 01/04/2023] Open
Abstract
PURPOSE For the target treatment and prevention of women's increased thyroid cancer, we focused on risks of environmental exposure to endocrine disrupting chemicals, particularly bisphenol A (BPA), and its high susceptible exposure-timing, particularly early exposure in lives. MATERIALS AND METHODS Female ICR mice were exposed to BPA in utero and in early life (15, 75, and 300 mg/L of drinking water via pregnant mice and lactation). We identified BPA-responsive proteins in mice thyroid by two-dimensional gel electrophoresis, image analyses, and electrospray ionization quadrupole time-of-flight mass spectrometry. We further analyzed expression of the BPA-responsive proteins in women thyroid cancer patients (n=28). RESULTS We found the altered 17 proteins in BPA dose-dependent manner among the thyroid tissues of offspring mice and identified nine proteins of them, including Anxa6, Atp5b, Hspa5, and Vcp, etc. In addition, we observed the positive association between blood BPA levels and mRNA expression of the ANXA6 and VCP not in normal but thyroid cancer tissues. CONCLUSION Our study provides ANXA6 and VCP as proteomic biomarkers for BPA-early life exposure and their potential for women's thyroid cancer.
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Affiliation(s)
- Ho-Sun Lee
- Department of Toxicology, Research Center for Cell Fate Control, College of Pharmacy, Sookmyung Women’s University, Seoul, Korea
| | - Yunkyeong Kang
- Department of Toxicology, Research Center for Cell Fate Control, College of Pharmacy, Sookmyung Women’s University, Seoul, Korea
| | - Kyung Tae
- Department of Otolaryngology, Hanyang University College of Medicine, Seoul, Korea
| | - Gyu-Un Bae
- Department of Anatomy and Pathology, Research Center for Cell Fate Control, College of Pharmacy, Sookmyung Women’s University, Seoul, Korea
| | - Jong Y. Park
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Yoon Hee Cho
- Department of Biomedical and Pharmaceutical Sciences, College of Health Professions and Biomedical Sciences, University of Montana, Missoula, MT, USA
| | - Mihi Yang
- Department of Toxicology, Research Center for Cell Fate Control, College of Pharmacy, Sookmyung Women’s University, Seoul, Korea
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Abstract
OBJECTIVE To provide insight into how and in what clinical fields overdiagnosis is studied and give directions for further applied and methodological research. DESIGN Scoping review. DATA SOURCES Medline up to August 2017. STUDY SELECTION All English studies on humans, in which overdiagnosis was discussed as a dominant theme. DATA EXTRACTION Studies were assessed on clinical field, study aim (ie, methodological or non-methodological), article type (eg, primary study, review), the type and role of diagnostic test(s) studied and the context in which these studies discussed overdiagnosis. RESULTS From 4896 studies, 1851 were included for analysis. Half of all studies on overdiagnosis were performed in the field of oncology (50%). Other prevalent clinical fields included mental disorders, infectious diseases and cardiovascular diseases accounting for 9%, 8% and 6% of studies, respectively. Overdiagnosis was addressed from a methodological perspective in 20% of studies. Primary studies were the most common article type (58%). The type of diagnostic tests most commonly studied were imaging tests (32%), although these were predominantly seen in oncology and cardiovascular disease (84%). Diagnostic tests were studied in a screening setting in 43% of all studies, but as high as 75% of all oncological studies. The context in which studies addressed overdiagnosis related most frequently to its estimation, accounting for 53%. Methodology on overdiagnosis estimation and definition provided a source for extensive discussion. Other contexts of discussion included definition of disease, overdiagnosis communication, trends in increasing disease prevalence, drivers and consequences of overdiagnosis, incidental findings and genomics. CONCLUSIONS Overdiagnosis is discussed across virtually all clinical fields and in different contexts. The variability in characteristics between studies and lack of consensus on overdiagnosis definition indicate the need for a uniform typology to improve coherence and comparability of studies on overdiagnosis.
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Affiliation(s)
- Kevin Jenniskens
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Joris A H de Groot
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Johannes B Reitsma
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Dutch Cochrane Centre, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Karel G M Moons
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Dutch Cochrane Centre, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lotty Hooft
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Dutch Cochrane Centre, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Christiana A Naaktgeboren
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Bae JM. Strategies for Appropriate Patient-centered Care to Decrease the Nationwide Cost of Cancers in Korea. J Prev Med Public Health 2017; 50:217-227. [PMID: 28768400 PMCID: PMC5541273 DOI: 10.3961/jpmph.17.069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 06/16/2017] [Indexed: 12/29/2022] Open
Abstract
In terms of years of life lost to premature mortality, cancer imposes the highest burden in Korea. In order to reduce the burden of cancer, the Korean government has implemented cancer control programs aiming to reduce cancer incidence, to increase survival rates, and to decrease cancer mortality. However, these programs may paradoxically increase the cost burden. For examples, a cancer screening program for early detection could bring about over-diagnosis and over-treatment, and supplying medical services in a paternalistic manner could lead to defensive medicine or futile care. As a practical measure to reduce the cost burden of cancer, appropriate cancer care should be established. Ensuring appropriateness requires patient-doctor communication to ensure that utility values are shared and that autonomous decisions are made regarding medical services. Thus, strategies for reducing the cost burden of cancer through ensuring appropriate patient-centered care include introducing value-based medicine, conducting cost-utility studies, and developing patient decision aids.
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Affiliation(s)
- Jong-Myon Bae
- Department of Preventive Medicine, Jeju National University School of Medicine, Jeju, Korea
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Yamashita S, Saenko VA. What Is the "Screening Effect" Six Years After the Fukushima Nuclear Power Plant Accident? Thyroid 2017; 27:595-596. [PMID: 28325113 DOI: 10.1089/thy.2017.0154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Shunichi Yamashita
- 1 Department of Radiation Medical Sciences, Atomic Bomb Disease Institute, Nagasaki University , Nagasaki, Japan
- 2 Radiation Medical Science Center for the Fukushima Health Management Survey, Fukushima Medical University , Fukushima, Japan
| | - Vladimir A Saenko
- 3 Department of Radiation Molecular Epidemiology, Atomic Bomb Disease Institute, Nagasaki University , Nagasaki, Japan
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Saint-Martin C, Dramé M, Dabakuyo S, Kanagaratnam L, Arveux P, Schvartz C. Overdiagnosis of thyroid cancer in the Marne and Ardennes Departments of France from 1975 to 2014. ANNALES D'ENDOCRINOLOGIE 2016; 78:27-32. [PMID: 27641079 DOI: 10.1016/j.ando.2016.07.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 07/01/2016] [Accepted: 07/07/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Incidence of thyroid cancer has increased considerably in France in recent years, but the mortality rate has declined only slightly. Part of this increased incidence could be attributable to overdiagnosis. We aimed to estimate the contribution of overdiagnosis to the incidence of papillary thyroid cancer. MATERIAL AND METHODS Incidence rates were calculated based on data from the specialised Marnes-Ardennes thyroid cancer registry, for cancers diagnosed between 1975 and 2014, by age category and by five-year period. The population was divided into two groups according to pTNM classification at diagnosis (i.e. localised or invasive). Overdiagnosis was defined as the difference in incidence rates between the invasive cancer and localised cancer groups. This rate was then divided by the incidence rate in the localised cancer group for the most recent period (2010-2014) to obtain the proportion of cancers attributable to overdiagnosis. RESULTS In total, 2008 patients were included. The proportion of incidence attributable to overdiagnosis for the period 2010-2014 was estimated at 7 and 62% in men and women aged < 50 years respectively, and at 65 and 73% respectively in men and women aged ≥ 50 years. CONCLUSION We observed a high proportion of cancers attributable to overdiagnosis. This finding raises the issue of patient management, with the risk of overtreatment, and the repercussions on quality of life for patients diagnosed with cancer.
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Affiliation(s)
| | - Moustapha Dramé
- EA 3757, University of Reims Champagne-Ardenne, Faculty of Medicine, 51095 Reims, France; Department of Research and Innovation, Reims Teaching Hospitals, Robert-Debré Hospital, rue du Général-Koenig, 51092 Reims, France.
| | | | - Lukshe Kanagaratnam
- EA 3757, University of Reims Champagne-Ardenne, Faculty of Medicine, 51095 Reims, France; Department of Research and Innovation, Reims Teaching Hospitals, Robert-Debré Hospital, rue du Général-Koenig, 51092 Reims, France
| | - Patrick Arveux
- Côte-d'Or Breast Cancer Registry, Georges-François-Leclerc Center, 21000 Dijon, France
| | - Claire Schvartz
- Thyroid Cancer Registry, Institut Jean-Godinot, 51100 Reims, France
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Nixon IJ, Suárez C, Simo R, Sanabria A, Angelos P, Rinaldo A, Rodrigo JP, Kowalski LP, Hartl DM, Hinni ML, Shah JP, Ferlito A. The impact of family history on non-medullary thyroid cancer. Eur J Surg Oncol 2016; 42:1455-63. [PMID: 27561845 DOI: 10.1016/j.ejso.2016.08.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 07/03/2016] [Accepted: 08/04/2016] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Around 10% of patients with non-medullary thyroid cancer (NMTC) will have a positive family history for the disease. Although many will be sporadic, families where 3 first-degree relatives are affected can be considered to represent true familial non-medullary thyroid cancer (FNMTC). The genetic basis, impact on clinical and pathological features, and overall effect on prognosis are poorly understood. METHODS A literature review identified articles which report on genetic, clinical, therapeutic and screening aspects of FNMTC. The results are presented to allow an understanding of the genetic basis and the impact on clinical-pathological features and prognosis in order to inform clinical decision making. RESULTS The genetic basis of FNMTC is unknown. Despite this, significant progress has been made in identifying potential susceptibility genes. The lack of a test for FNMTC has led to a clinical definition requiring a minimum of 3 first-degree relatives to be diagnosed with NMTC. Although some have shown an association with multi-centric disease, younger age and increased rates of extra-thyroidal extension and nodal metastases, these findings are not supported by all. The impact of FNMTC is unclear with all groups reporting good outcome, and some finding an association with more aggressive disease. The role of screening remains controversial. CONCLUSION FNMTC is rare but can be diagnosed clinically. Its impact on prognostic factors and the subsequent role in influencing management is debated. For those patients who present with otherwise low-risk differentiated thyroid cancer, FNMTC should be included in risk assessment when discussing therapeutic options.
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Affiliation(s)
- I J Nixon
- Department of ENT/Head and Neck Surgery, NHS Lothian, Edinburgh University, UK; Department of Otolaryngology, Head and Neck Surgery, NHS Lothian, Edinburgh University, UK.
| | - C Suárez
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain; Fundación de Investigación e Innovación Biosanitaria del Principado de Asturias, Oviedo, Spain
| | - R Simo
- Head and Neck Cancer Unit, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - A Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia, Fundación Colombiana de Cancerología - Clínica Vida, Medellin, Colombia
| | - P Angelos
- Department of Surgery and Surgical Ethics, The University of Chicago Medicine, Chicago, IL, USA
| | - A Rinaldo
- University of Udine School of Medicine, Udine, Italy
| | - J P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto Universitario de Oncología del Principado de Asturias, University of Oviedo, Oviedo, Spain
| | - L P Kowalski
- Department of Head and Neck Surgery and Otorhinolaryngology, A.C. Camargo Cancer Center, Sao Paulo, SP, Brazil
| | - D M Hartl
- Department of Otolaryngology-Head and Neck Surgery, Institut Gustave Roussy, Villejuif Cedex, France; Laboratoire de Phonétique et de Phonologie, Sorbonne Nouvelle, Paris, France
| | - M L Hinni
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - J P Shah
- Head and Neck Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - A Ferlito
- Department of Surgical Sciences, ENT Clinic, University of Udine School of Medicine, Udine; International Head and Neck Scientific Group, Italy
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14
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Margo CE. Are Ocular and Ocular Adnexal Cancers Overdiagnosed? Historical Perspectives on Diagnosis. Cancer Control 2016; 23:90-2. [PMID: 27218784 DOI: 10.1177/107327481602300201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Curtis E Margo
- Department of Pathology and Cell Biology, Department of Ophthalmology, University of South Florida Morsani College of Medicine, Tampa 33612, USA.
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15
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Bae JM. Development and application of patient decision aids. Epidemiol Health 2015; 37:e2015018. [PMID: 25868639 PMCID: PMC4430759 DOI: 10.4178/epih/e2015018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 04/02/2015] [Indexed: 11/29/2022] Open
Abstract
With the current overdiagnosis of thyroid cancer resulting from routine screening in Korea, it is necessary to educate the public that not all cancers are malignant. The exposure to patient decision aids (PtDAs) compared to usual care reduced the number of people choosing to undergo prostate-specific antigen screening. This article introduces the definition, usefulness, and developmental processes of PtDAs and suggests the urgent need for a Korean PtDA related to thyroid cancer screening.
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Affiliation(s)
- Jong-Myon Bae
- Department of Preventive Medicine, Jeju National University School of Medicine, Jeju, Korea
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16
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Bae JM. Epidemiological evidences on overdiagnosis of prostate and kidney cancers in Korean. Epidemiol Health 2015; 37:e2015015. [PMID: 25773442 PMCID: PMC4398977 DOI: 10.4178/epih/e2015015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 03/07/2015] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES: The prostate specific antigen test is widely used as the main method of screening prostate cancer in Korea. Additionally, the use of ultrasound sonography may lead to overdiagnosis of kidney cancer as well as thyroid cancer. This study aimed to highlight epidemiological evidences regarding overdiagnosis of prostate and kidney cancers in Korean. METHODS: The annual trends of national incidence and mortality of prostate and kidney cancers provided by the Korean Statistical Information Service were evaluated. RESULTS: The rate of increase in the incidence of prostate and kidney cancer was 6 and 5 times higher than that of mortality between 2000 and 2011, respectively. Additionally, the age group showing the highest incidence in prostate cancer shifted from 85 years and older to 75-79 years. CONCLUSIONS: This evidence suggests that prostate and kidney cancers are overdiagnosed in Korea. Further research in this area, using national cancer registry databases, should be encouraged to prevent overdiagnosis.
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Affiliation(s)
- Jong-Myon Bae
- Department of Preventive Medicine, Jeju National University School of Medicine, Jeju, Korea
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17
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Bae JM. It needs adaptation to the 2015 Korean guideline for breast cancer screening. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2015. [DOI: 10.5124/jkma.2015.58.9.833] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Jong-Myon Bae
- Department of Preventive Medicine, Jeju National University School of Medicine, Jejudo, Korea
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