Overdiagnosis

The ClinSeq study I'm enrolled may, at some point, discover something "wrong" with me. In that connection, an essay in today's Times is especially relevant:

Early screening is like the “check engine” light in your car. It can alert you to problems that need to be fixed, but too often it picks up trivial abnormalities that don’t affect performance, like one sensor’s recognizing that another sensor isn’t sensing.

And if we look hard enough, we’ll probably find out that one of your check-engine lights is on.

Overdiagnosis occurs even among what were once considered uniformly deadly diseases.

When it comes to cancer, for example, there is a very broad spectrum of diseases. Some kill rapidly, some progress slowly, and some do not progress at all.

That is why some doctors recommend “watchful waiting” for men with early prostate cancer: most cases never prove fatal. It was because of concerns about overdiagnosis that the United States Preventive Services Task Force recently recommended against prostate cancer screening in men over 75. Similar phenomena have been documented in early-stage breast cancer, lung cancer and melanoma.

Most diseases exist along a similar spectrum. Even without treatment, most cases of aortic aneurysm never result in a fatal rupture, most patients with osteoporosis won’t fracture their hip, and most people with diabetes won’t lose a limb.

It’s hard to ignore a “check-engine” light. Some mechanics reset them and see if they come on again, but often they lead you to a repair. And you may have had the unfortunate experience that a repair makes matters worse.

If so, you have some feel for the problem of overdiagnosis.

"Campaign Myth: Prevention as Cure-All"
Italics are mine.