Solving the Problem of Overdiagnosis


Joann G. Elmore, M.D., M.P.H.

N Engl J Med 2016; 375:1483-1486October 13, 2016DOI: 10.1056/NEJMe1608683

This article has no abstract; the first 100 words appear below.

My patients’ fear of breast cancer is palpable. I see them fret over whether or not to have a mammogram, worry about false positive abnormalities, and struggle to pay for diagnostic evaluations for which they are not reimbursed. This collateral damage of screening is obvious to clinicians. However, increasing evidence now indicates a less obvious outcome of cancer screening — overdiagnosis of diseases that would never cause symptoms or death. The presence and effects of overdiagnosis are less tangible, buried in population statistics rather than patient encounters. Overdiagnosis of breast cancer has been suggested on the basis of multiple studies . . .

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From the Department of Medicine, University of Washington School of Medicine, Seattle.


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