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Colbert L, Hegazi I, Peters K, Edmiston N. Medical students' awareness of overdiagnosis and implications for preventing overdiagnosis. BMC MEDICAL EDUCATION 2024; 24:256. [PMID: 38459476 PMCID: PMC10921797 DOI: 10.1186/s12909-024-05219-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 02/23/2024] [Indexed: 03/10/2024]
Abstract
Overdiagnosis is a growing health issue, yet our understanding of medical students' exposure to this concept within medical education is limited. Our aim was to explore students' experience of diagnostic learning to identify how overdiagnosis may be understood by students. During in-person and online semi-structured interviews throughout 2021, we explored the education experience of twelve Western Sydney University medical students in years 3-5. Through inductive thematic analysis we identified four themes. These themes encompassed student commitment to learning about diagnosis, lack of certainty surrounding diagnosis and emotional factors of medical care, overdiagnosis as seen through the lens of high and low-value care during clinical placements and student-identified missed learning opportunities related to overdiagnosis. This study found that medical students develop inherent knowledge of overdiagnosis through an interplay of personal factors, medical school curriculum and the setting in which their training takes place. Our findings allow insight for future improvement of medical curriculum to produce exceptional medical graduates.
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Affiliation(s)
- Lucinda Colbert
- Hervey Bay Hospital, Wide Bay Hospital and Health Service, Hervey Bay, QLD, Australia
| | - Iman Hegazi
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
| | - Kath Peters
- School of Nursing and Midwifery, Western Sydney University, Campbelltown, NSW, Australia
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2
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Stevens P, Hunter J, Molodysky E. The role of hyperinsulinaemia in screening for prediabetes in the adolescent population: A systematic literature review. Diabetes Metab Syndr 2022; 16:102445. [PMID: 35305511 DOI: 10.1016/j.dsx.2022.102445] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 02/22/2022] [Accepted: 02/24/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND/AIMS Present screening methods for Type 2 diabetes (T2DM) fall short of detecting prediabetes. This paper summarises the literature on the utility of insulin measurements (hyperinsulinemia) in detecting prediabetes in adolescents. METHODS A systematic literature review was conducted using EMBASE and Medline. Relevant data on hyperinsulinemia in the adolescent population is narrated. RESULTS The database search identified 174 potential articles; 106 underwent a full-paper review, and 36 were included. CONCLUSION Elevated fasting insulin is a marker of impaired insulin resistance and pending beta-cell dysfunction in at-risk adolescents and can be an early indicator of prediabetes.
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Jankauskaite L, Grechukha Y, Kjær KA, Mamenko M, Nakstad B, Romankevych I, Schnyder S, Selvakumar J, Trapani S, Daniliaviciene S, Valiulis A, Wyder C, Størdal K. Overuse of medical care in paediatrics: A survey from five countries in the European Academy of Pediatrics. Front Pediatr 2022; 10:945540. [PMID: 36177454 PMCID: PMC9513058 DOI: 10.3389/fped.2022.945540] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/25/2022] [Indexed: 11/13/2022] Open
Abstract
UNLABELLED Studies and initiatives such as the "Choosing wisely" (CW) campaign emphasise evidence-based investigations and treatment to avoid overdiagnosis and overtreatment. The perception of the extent of medical overactivity among professionals and drivers behind are not well studied in the paediatric field. AIM We aimed to investigate the physicians' opinion and clarify the main drivers regarding medical overactivity in member countries of the European Academy of Paediatrics (EAP). METHODS In this study, paediatricians, paediatric residents, primary care paediatricians, and family doctors treating children were surveyed in Norway, Lithuania, Ukraine, Italy, and Switzerland. Over-investigation was defined as "diagnostic work-up or referral that is unlikely to provide information which is relevant for a patient" and overtreatment was defined as "treatment that does not benefit or can harm more than benefit the patient." The original questionnaire was developed in 2018 by a working group from the Norwegian Paediatric Association. RESULTS Overall, 1,416 medical doctors participated in the survey, ranging from 144 in Lithuania to 337 in Switzerland. 83% stated that they experienced over-investigation/overtreatment, and 81% perceived this as a problem. The majority (83%) perceived expectations from family and patients as the most important driver for overtreatment in their country. Other drivers for overuse were use of national guidelines/recommendations, worry for reactions, and reduction of uncertainty. CONCLUSION This is the first study investigating knowledge and attitude toward medical overactivity in European countries. Despite different cultural and economic environments, the patterns and drivers of increased investigations and medicalisation are similar.
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Affiliation(s)
- Lina Jankauskaite
- Department of Paediatrics, Lithuanian University of Health Sciences, Kaunas, Lithuania.,Institute of Physiology and Pharmacology, Lithuanian University of Health Sciences, Kaunas, Lithuania.,European Academy of Paediatrics, Brussels, Belgium
| | - Yevgenii Grechukha
- European Academy of Paediatrics, Brussels, Belgium.,Department of Paediatric Infectious Diseases and Paediatric Immunology, Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine
| | | | - Marina Mamenko
- European Academy of Paediatrics, Brussels, Belgium.,Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine.,Ukrainian Academy of Paediatric Specialties, Kyiv, Ukraine
| | - Britt Nakstad
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.,Department of Paediatrics and Adolescent Health, University of Botswana, Gaborone, Botswana
| | - Ivanna Romankevych
- European Academy of Paediatrics, Brussels, Belgium.,Ukrainian Academy of Paediatric Specialties, Kyiv, Ukraine.,Miller School of Medicine, Jackson Memorial Hospital, University of Miami, Coral Gables, FL, United States
| | - Sara Schnyder
- European Academy of Paediatrics, Brussels, Belgium.,Division of Paediatric Emergency Medicine, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Joel Selvakumar
- Department of Paediatric and Adolescent Health, Akershus University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Sandra Trapani
- European Academy of Paediatrics, Brussels, Belgium.,Paediatric Unit, Department of Health Sciences, Meyer Children's Hospital, University of Florence, Florence, Italy
| | - Sandra Daniliaviciene
- Karoliniskiu Policlinic, Vilnius, Lithuania.,Clinic of Children's Diseases, Institute of Clinical Medicine, Medical Faculty of Vilnius University, Vilnius, Lithuania
| | - Arunas Valiulis
- European Academy of Paediatrics, Brussels, Belgium.,Clinic of Children's Diseases, Institute of Clinical Medicine, Medical Faculty of Vilnius University, Vilnius, Lithuania.,Human Ecology Research Group, Department of Public Health, Institute of Health Sciences, Medical Faculty of Vilnius University, Vilnius, Lithuania
| | - Corinne Wyder
- European Academy of Paediatrics, Brussels, Belgium.,Paediatric Praxis Kurwerk, Burgdorf, Switzerland
| | - Ketil Størdal
- European Academy of Paediatrics, Brussels, Belgium.,Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.,Department of Paediatric Research, University of Oslo, Oslo, Norway
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4
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Affiliation(s)
- Ian A Harris
- Liverpool Hospital in Sydney
- School of Public Health, University of Sydney
| | - Rachelle Buchbinder
- Department of Epidemiology and Preventive Medicine, Monash University
- Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health
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5
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Rozbroj T, Haas R, O'Connor D, Carter SM, McCaffery K, Thomas R, Donovan J, Buchbinder R. How do people understand overtesting and overdiagnosis? Systematic review and meta-synthesis of qualitative research. Soc Sci Med 2021; 285:114255. [PMID: 34391966 DOI: 10.1016/j.socscimed.2021.114255] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 11/15/2022]
Abstract
RATIONALE The public should be informed about overtesting and overdiagnosis. Diverse qualitative studies have examined public understandings of this information. A synthesis was needed to systematise the body of evidence and yield new, generalisable insights. AIM Synthesise data from qualitative studies exploring patient and public understanding of overtesting and overdiagnosis. METHODS We searched Scopus, CINAHL, Ovid MEDLINE and PsycINFO databases from inception to March 18, 2020. We included published English-language primary studies exploring the perspectives of patients/the public about overtesting/overdiagnosis from any setting, year and relating to any condition. Only qualitative parts of mixed-methods studies were synthesised. We excluded studies that only examined overtreatment or sampled people with specialised medical knowledge. Two authors independently selected studies, extracted data, assessed the methodological quality of included studies using the CASP tool, and assessed confidence in the synthesis findings using the GRADE-CERQual approach. Data was analysed using thematic meta-synthesis, utilising descriptive and interpretive methods. RESULTS We synthesised data from 21 studies, comprising 1638 participants, from 2754 unique records identified. We identified six descriptive themes, all graded as moderate confidence (indicating they are likely to reasonably represent the available evidence): i) high confidence in screening and testing; ii) difficulty in understanding overuse; iii) acceptance that overuse can be harmful; iv) rejection or problematisation of overuse; v) limited impacts of overuse information on intended test and screening uptake; vi) desire for information and shared decision-making regarding overuse. The descriptive themes were underpinned by two analytic themes: i) perceived intrinsic value of information and information gathering, and; ii) differences in comprehension and acceptance of overuse concepts. CONCLUSIONS This study identified novel and important insights about how lay people interpret overuse concepts. It will guide the development of more effective public messages about overuse, highlighting the importance of interpretative frameworks in these communications.
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Affiliation(s)
- Tomas Rozbroj
- Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, 154 Wattletree Rd, Malvern, VIC 3144, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, VIC 3004, Australia.
| | - Romi Haas
- Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, 154 Wattletree Rd, Malvern, VIC 3144, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, VIC 3004, Australia
| | - Denise O'Connor
- Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, 154 Wattletree Rd, Malvern, VIC 3144, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, VIC 3004, Australia
| | - Stacy M Carter
- Australian Centre for Health Engagement, Evidence and Values, University of Wollongong, NSW 2500, Australia
| | - Kirsten McCaffery
- Sydney Health Literacy Lab, School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Rae Thomas
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, QLD, Australia
| | - Jan Donovan
- Consumers Health Forum of Australia, 7B/17 Napier Close, Deakin, ACT 2600, Australia
| | - Rachelle Buchbinder
- Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, 154 Wattletree Rd, Malvern, VIC 3144, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, VIC 3004, Australia
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6
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Zurynski Y, Ansell J, Ellis LA, Pomare C, Smith CL, Holt J, Root J, Gillespie J, Wells L, Braithwaite J. Accessible and affordable healthcare? Views of Australians with and without chronic conditions. Intern Med J 2020; 51:1060-1067. [PMID: 33350562 PMCID: PMC8361684 DOI: 10.1111/imj.15172] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 12/03/2020] [Accepted: 12/07/2020] [Indexed: 12/01/2022]
Abstract
Background With 50% of Australians having chronic disease, health consumer views are an important barometer of the ‘health’ of the healthcare system for system improvement and sustainability. Aims To describe the views of Australian health consumers with and without chronic conditions when accessing healthcare. Methods A survey of a representative sample of 1024 Australians aged over 18 years, distributed electronically and incorporating standardised questions and questions co‐designed with consumers. Results Respondents were aged 18–88 years (432 males, 592 females) representing all states and territories, and rural and urban locations. General practices (84.6%), pharmacies (62.1%) and public hospitals (32.9%) were the most frequently accessed services. Most care was received through face‐to‐face consultations; only 16.5% of respondents accessed care via telehealth. The 605 (59.0%) respondents with chronic conditions were less likely to have private health insurance (50.3% vs 57.9%), more likely to skip doses of prescribed medicines (53.6% vs 28.6%), and miss appointments with doctors (15.3% vs 10.1%) or dentists (52.8% vs 40.4%) because of cost. Among 480 respondents without private health insurance, unaffordability (73.5%) or poor value for money (35.3%) were the most common reasons. Most respondents (87.7%) were confident that they would receive high quality and safe care. However, only 57% of people with chronic conditions were confident that they could afford needed healthcare compared with 71.3% without. Conclusions Health consumers, especially those with chronic conditions, identified significant cost barriers to access of healthcare. Equitable access to healthcare must be at the centre of health reform.
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Affiliation(s)
- Yvonne Zurynski
- NHMRC Partnership Centre for Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.,Centre for Health Research and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - James Ansell
- Consumers Health Forum of Australia, Canberra, Australian Capital Territory, Sydney, New South Wales, Australia
| | - Louise A Ellis
- NHMRC Partnership Centre for Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.,Centre for Health Research and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Chiara Pomare
- Centre for Health Research and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Carolynn L Smith
- NHMRC Partnership Centre for Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Joanna Holt
- NHMRC Partnership Centre for Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.,Centre for Health Research and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Jo Root
- Consumers Health Forum of Australia, Canberra, Australian Capital Territory, Sydney, New South Wales, Australia
| | - James Gillespie
- Menzies Centre for Health Policy and Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Leanne Wells
- Consumers Health Forum of Australia, Canberra, Australian Capital Territory, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- NHMRC Partnership Centre for Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia.,Centre for Health Research and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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7
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Lam JH, Pickles K, Stanaway FF, Bell KJL. Why clinicians overtest: development of a thematic framework. BMC Health Serv Res 2020; 20:1011. [PMID: 33148242 PMCID: PMC7643462 DOI: 10.1186/s12913-020-05844-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 10/21/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Medical tests provide important information to guide clinical management. Overtesting, however, may cause harm to patients and the healthcare system, including through misdiagnosis, false positives, false negatives and overdiagnosis. Clinicians are ultimately responsible for test requests, and are therefore ideally positioned to prevent overtesting and its unintended consequences. Through this narrative literature review and workshop discussion with experts at the Preventing Overdiagnosis Conference (Sydney, 2019), we aimed to identify and establish a thematic framework of factors that influence clinicians to request non-recommended and unnecessary tests. METHODS Articles exploring factors affecting clinician test ordering behaviour were identified through a systematic search of MedLine in April 2019, forward and backward citation searches and content experts. Two authors screened abstract titles and abstracts, and two authors screened full text for inclusion. Identified factors were categorised into a preliminary framework which was subsequently presented at the PODC for iterative development. RESULTS The MedLine search yielded 542 articles; 55 were included. Another 10 articles identified by forward-backward citation and content experts were included, resulting in 65 articles in total. Following small group discussion with workshop participants, a revised thematic framework of factors was developed: "Intrapersonal" - fear of malpractice and litigation; clinician knowledge and understanding; intolerance of uncertainty and risk aversion; cognitive biases and experiences; sense of medical obligation "Interpersonal" - pressure from patients and doctor-patient relationship; pressure from colleagues and medical culture; "Environment/context" - guidelines, protocols and policies; financial incentives and ownership of tests; time constraints, physical vulnerabilities and language barriers; availability and ease of access to tests; pre-emptive testing to facilitate subsequent care; contemporary medical practice and new technology CONCLUSION: This thematic framework may raise awareness of overtesting and prompt clinicians to change their test request behaviour. The development of a scale to assess clinician knowledge, attitudes and practices is planned to allow evaluation of clinician-targeted interventions to reduce overtesting.
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Affiliation(s)
- Justin H Lam
- Faculty of Medicine and Health, The University of Sydney School of Public Health, Edward Ford Building, A27 Fisher Rd, University of Sydney, Sydney, NSW, 2066, Australia.
| | - Kristen Pickles
- Faculty of Medicine and Health, The University of Sydney School of Public Health, Edward Ford Building, A27 Fisher Rd, University of Sydney, Sydney, NSW, 2066, Australia
| | - Fiona F Stanaway
- Faculty of Medicine and Health, The University of Sydney School of Public Health, Edward Ford Building, A27 Fisher Rd, University of Sydney, Sydney, NSW, 2066, Australia
| | - Katy J L Bell
- Faculty of Medicine and Health, The University of Sydney School of Public Health, Edward Ford Building, A27 Fisher Rd, University of Sydney, Sydney, NSW, 2066, Australia
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8
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Affiliation(s)
- Athina Tatsioni
- Research Unit for General Medicine and Primary Health Care, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - John P A Ioannidis
- Departments of Medicine, of Epidemiology and Population Health, of Biomedical Data Science and of Statistics, and Meta-Research Innovation Center at Stanford (METRICS), Stanford University, Stanford, CA, USA
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9
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Maher CG, O'Keeffe M, Buchbinder R, Harris IA. Musculoskeletal healthcare: Have we over-egged the pudding? Int J Rheum Dis 2020; 22:1957-1960. [PMID: 31722450 PMCID: PMC6899869 DOI: 10.1111/1756-185x.13710] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 09/03/2019] [Indexed: 02/04/2023]
Affiliation(s)
- Christopher G Maher
- Institute for Musculoskeletal Health, Sydney, NSW, Australia.,School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Mary O'Keeffe
- Institute for Musculoskeletal Health, Sydney, NSW, Australia.,School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Rachelle Buchbinder
- Monash Department of Clinical Epidemiology, Cabrini Institute, Melbourne, Vic., Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - I A Harris
- Institute for Musculoskeletal Health, Sydney, NSW, Australia.,School of Public Health, The University of Sydney, Sydney, NSW, Australia.,South Western Sydney Clinical School, Ingham Institute for Applied Medical Research, Sydney, NSW, Australia
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Mitchison D, Mond J, Bussey K, Griffiths S, Trompeter N, Lonergan A, Pike KM, Murray SB, Hay P. DSM-5 full syndrome, other specified, and unspecified eating disorders in Australian adolescents: prevalence and clinical significance. Psychol Med 2020; 50:981-990. [PMID: 31043181 DOI: 10.1017/s0033291719000898] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Little information is available on the prevalence of Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 eating disorders in adolescence, and eating disorders remain unique in the DSM for not systematically including a criterion for clinical significance. This study aimed to provide the first prevalence report of the full suite of DSM-5 eating disorders in adolescence, and to examine the impact of applying a criterion for clinical significance. METHODS In total, 5191 (participation rate: 70%) Australian adolescents completed a survey measuring 1-month prevalence of eating disorder symptoms for all criterial, 'other specified' and unspecified eating disorders, as well as health-related quality of life and psychological distress. RESULTS The point prevalence of any eating disorder was 22.2% (12.8% in boys, 32.9% in girls), and 'other specified' disorders (11.2%) were more common than full criterial disorders (6.2%). Probable bulimia nervosa and binge eating disorder, but not anorexia nervosa (AN), were more likely to be experienced by older adolescents. Most disorders were associated with an increased odds for being at a higher weight. The prevalence of eating disorders was reduced by 40% (to 13.6%) when a criterion for clinical significance was applied. CONCLUSIONS Eating disorders, particularly 'other specified' syndromes, are common in adolescence, and are experienced across age, weight, socioeconomic and migrant status. The merit of adding a criterion for clinical significance to the eating disorders, similar to other DSM-5 disorders, warrants consideration. At the least, screening tools should measure distress and impairment associated with eating disorder symptoms in order to capture adolescents in greatest need for intervention.
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Affiliation(s)
- Deborah Mitchison
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia
- Department of Psychology, Macquarie University, Sydney, Australia
| | - Jonathan Mond
- Centre for Rural Health, University of Tasmania, Launceston, Australia
- School of Medicine, Western Sydney University, Sydney, Australia
| | - Kay Bussey
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia
| | - Scott Griffiths
- School for Psychological Sciences, University of Melbourne, Sydney, Australia
| | - Nora Trompeter
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia
| | - Alexandra Lonergan
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia
| | - Kathleen M Pike
- Departments of Psychiatry and Epidemiology, Columbia University, New York, USA
| | - Stuart B Murray
- Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, Australia
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11
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Glasziou PP, Jones MA, Pathirana T, Barratt AL, Bell KJ. Estimating the magnitude of cancer overdiagnosis in Australia. Med J Aust 2019; 212:163-168. [PMID: 31858624 PMCID: PMC7065073 DOI: 10.5694/mja2.50455] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 09/27/2019] [Indexed: 12/24/2022]
Abstract
Objectives To estimate the proportion of cancer diagnoses in Australia that might reasonably be attributed to overdiagnosis by comparing current and past lifetime risks of cancer. Design, setting, and participants Routinely collected Australian Institute of Health and Welfare national data were analysed to estimate recent (2012) and historical (1982) lifetime risks (adjusted for competing risk of death and changes in risk factors) of diagnoses with five cancers: prostate, breast, renal, thyroid cancers, and melanoma. Main outcome measure Difference in lifetime risks of cancer diagnosis between 1982 and 2012, interpreted as probable overdiagnosis. Results For women, absolute lifetime risk increased by 3.4 percentage points for breast cancer (invasive cancers, 1.7 percentage points), 0.6 percentage point for renal cancer, 1.0 percentage point for thyroid cancer, and 5.1 percentage points for melanoma (invasive melanoma, 0.7 percentage point). An estimated 22% of breast cancers (invasive cancers, 13%), 58% of renal cancers, 73% of thyroid cancers, and 54% of melanomas (invasive melanoma, 15%) were overdiagnosed, or 18% of all cancer diagnoses (8% of invasive cancer diagnoses). For men, absolute lifetime risk increased by 8.2 percentage points for prostate cancer, 0.8 percentage point for renal cancer, 0.4 percentage point for thyroid cancer, and 8.0 percentage points for melanoma (invasive melanoma, 1.5 percentage points). An estimated 42% of prostate cancers, 42% of renal cancers, 73% of thyroid cancers, and 58% of melanomas (invasive melanomas, 22%) were overdiagnosed, or 24% of all cancer diagnoses (16% of invasive cancer diagnoses). Alternative assumptions slightly modified the estimates for overdiagnosis of breast cancer and melanoma. Conclusions About 11 000 cancers in women and 18 000 in men may be overdiagnosed each year. Rates of overdiagnosis need to be reduced and health services should monitor emerging areas of overdiagnosis.
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Affiliation(s)
- Paul P Glasziou
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, QLD
| | - Mark A Jones
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, QLD
| | | | | | - Katy Jl Bell
- Sydney School of Public Health, University of Sydney, Sydney, NSW
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12
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Moynihan R, Brodersen J, Heath I, Johansson M, Kuehlein T, Minué-Lorenzo S, Petursson H, Pizzanelli M, Reventlow S, Sigurdsson J, Stavdal A, Treadwell J, Glasziou P. Reforming disease definitions: a new primary care led, people-centred approach. BMJ Evid Based Med 2019; 24:170-173. [PMID: 30962252 DOI: 10.1136/bmjebm-2018-111148] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Ray Moynihan
- Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, Queensland, Australia
| | | | - Iona Heath
- Royal College of General Practitioners, London, UK
| | | | | | | | | | | | | | | | | | | | - Paul Glasziou
- Centre for Research in Evidence-Based Practice (crebp.net.au), Robina, Queensland, Australia
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13
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Mendelson G. Australia is responding to the complex challenge of overdiagnosis. Med J Aust 2019; 210:525-525.e1. [DOI: 10.5694/mja2.50211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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14
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Molodysky E. Australia is responding to the complex challenge of overdiagnosis. Med J Aust 2019; 210:525-525.e1. [PMID: 31148171 DOI: 10.5694/mja2.50203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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15
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Moynihan R, Barratt AL, Glasziou PP. Australia is responding to the complex challenge of overdiagnosis. Med J Aust 2019; 210:525-525.e1. [PMID: 31119741 DOI: 10.5694/mja2.50197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | | | - Paul P Glasziou
- Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, QLD
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16
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Swannell C. Excellence in two worlds of medicine and journalism. Med J Aust 2018. [DOI: 10.5694/mja18.0511c1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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