The Harms of Screening
Cet article analyse les récentes controverses sur le rapport bénéfices/risques des programmes de dépistage du cancer aux Etats-Unis
Americans are enthusiastic about screening, especially cancer screening. What could be wrong with screening, especially if it can detect a life-threatening condition at an earlier stage? Trials show that early detection of breast, colorectal, and other cancers can reduce cause-specific mortality rates, and the same could apply to other conditions. With presumably little to lose and much to gain from early detection, why recommend against screening unless the concern is costs? Are lives being lost to save money?
But costs are rarely the reason that guidelines set limits on screening. Most screening controversies turn on how to balance potential harms relative to potential benefits. Harms from screening programs are real; the burden of these harms can be disputed, but their existence cannot. Screening can produce iatrogenic complications (eg, perforation from colonoscopy), anxiety over abnormal results, and a cascade of follow-up tests and treatments. Screening can also precipitate overdiagnosis, the …
JAMA: The Journal of the American Medical Association , commentaire, 2012