1-9 早期発見が必ずしも良いとは限らない

人は多くの場合、病気の早期発見がより良い転帰につながるとみなします。しかし、病気を発見するための検診は、2つの条件を満たした場合にのみ役立ちます。まず、有効性の高い治療が存在しなければなりません。次に、その病気が明らかになった後に治療を受ける人よりも、その病気が明らかになる前の段階で見つけて治療を受ける人の方が病気が良くならなければなりません。検診は、正確ではない場合もあります(例えば、病気のない人を病気があると誤って判定すること)。検診では、病気でない人を病気があると判定することや、検査や治療の副作用により、害を及ぼすこともあります。

検診を受けた人と受けなかった人との公正な比較をする系統的レビューで評価されていない場合、病気の早期発見は価値があるとみなさないでください。

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Know Your Chances

This book has been shown in two randomized trials to improve peoples' understanding of risk in the context of health care choices.

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Screen test

Ben Goldacre notes that even if people realize that screening programmes have downsides, people don’t regret being screened.

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Cancer Screening Debate

This blog discusses problems that can be associated with cancer screening, including over-diagnosis and thus (unnecessary) over-treatment.

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Alicia

Earlier testing is not always better, and can lead to overdiagnosis and overtreatment.

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Gertrud

Exaggeration and hopes or fears can lead to unrealistic expectations about treatment effects.

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Who has diabetes?

So how do we decide who has diabetes? When I was in medical school, our numerical rule was this: if […]

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From person to patient

Screening will inevitably turn some people who test ‘positive’ into patients – a transformation not to be undertaken lightly. ‘If […]

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The Screening Circus

In 2009, a recently retired professor of neurology with a long-standing interest in stroke prevention learnt that neighbours had received […]

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Selling screening

‘Selling screening can be easy. Induce fear by exaggerating risk. Offer hope by exaggerating the benefit of screening. And don’t […]

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Is anyone normal?

Whole-body CT scans Among the tests on offer at private clinics are whole-body computed tomography (CT) scans to look at […]

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