Over the past two decades a vast new armamentarium of diagnostictechniques has revolutionized the practice of medicine. Theentire human body can now be imaged in exquisite anatomicaldetail. Computed tomography (CT), magnetic resonance imaging(MRI), and ultrasonography routinely "section" patients intoslices less than a centimeter thick. Abnormalities can be detectedwell before they produce any clinical signs or symptoms. Undoubtedly,these technological advances have enhanced the physician's potentialfor understanding disease and treating patients.
Unfortunately, these technological advances also create confusionthat may ultimately be harmful to patients. Consider the caseof prostate cancer. Although the prevalence . . . [Full Text of this Article]
Prevalence of Disease
Abdominal Aortic Aneurysms
Cancer
Breast Cancer
Therapeutic Effectiveness
Lead-Time Bias
Length Bias
Apparent, Real, and Spurious Effects
The Cycle of Increasing Intervention
Conclusions
Source Information
From the Center for the Evaluative Clinical Sciences, Dartmouth Medical School, Hanover, N.H. (W.C.B., H.G.W.); the Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, N.H. (W.C.B.); and the Medical Service, Veterans Affairs Hospital, White River Junction, Vt. (H.G.W.).
Address reprint requests to Dr. Black at the Center for the Evaluative Clinical Sciences, Dartmouth Medical School, 318 Strausenburgh Hall, Hanover, NH 03755-3863.
References
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LARSEN, T. K., MELLE, I., FRIIS, S., JOA, I., JOHANNESSEN, J. O., OPJORDSMOEN, S., SIMONSEN, E., VAGLUM, P., McGLASHAN, T. H.
(2007). One-year effect of changing duration of untreated psychosis in a single catchment area. Br. J. Psychiatry
191: s128-s132
[Abstract][Full Text]
Beliveau, R., Gingras, D.
(2007). Role of nutrition in preventing cancer. cfp
53: 1905-1911
[Abstract][Full Text]
Lin, E. Y., Pollard, J. W.
(2007). Tumor-Associated Macrophages Press the Angiogenic Switch in Breast Cancer. Cancer Res.
67: 5064-5066
[Abstract][Full Text]
Hollingsworth, J. M., Miller, D. C., Daignault, S., Hollenbeck, B. K.
(2006). Rising incidence of small renal masses: a need to reassess treatment effect.. JNCI J Natl Cancer Inst
98: 1331-1334
[Abstract][Full Text]
Almog, N., Henke, V., Flores, L., Hlatky, L., Kung, A. L., Wright, R. D., Berger, R., Hutchinson, L., Naumov, G. N., Bender, E., Akslen, L. A., Achilles, E.-G., Folkman, J.
(2006). Prolonged dormancy of human liposarcoma is associated with impaired tumor angiogenesis. FASEB J.
20: 947-949
[Abstract][Full Text]
Narazaki, M., Tosato, G.
(2006). Tumor cell populations differ in angiogenic activity: a model system for spontaneous angiogenic switch can tell us why.. JNCI J Natl Cancer Inst
98: 294-295
[Full Text]
Naumov, G. N., Bender, E., Zurakowski, D., Kang, S.-Y., Sampson, D., Flynn, E., Watnick, R. S., Straume, O., Akslen, L. A., Folkman, J., Almog, N.
(2006). A model of human tumor dormancy: an angiogenic switch from the nonangiogenic phenotype.. JNCI J Natl Cancer Inst
98: 316-325
[Abstract][Full Text]
Concato, J., Wells, C. K., Horwitz, R. I., Penson, D., Fincke, G., Berlowitz, D. R., Froehlich, G., Blake, D., Vickers, M. A., Gehr, G. A., Raheb, N. H., Sullivan, G., Peduzzi, P.
(2006). The Effectiveness of Screening for Prostate Cancer: A Nested Case-Control Study. Arch Intern Med
166: 38-43
[Abstract][Full Text]
Swensen, S. J., Jett, J. R., Hartman, T. E., Midthun, D. E., Mandrekar, S. J., Hillman, S. L., Sykes, A.-M., Aughenbaugh, G. L., Bungum, A. O., Allen, K. L.
(2005). CT Screening for Lung Cancer: Five-year Prospective Experience. Radiology
235: 259-265
[Abstract][Full Text]
McCaffery, K. J, Barratt, A. L
(2004). Assessing psychosocial/quality of life outcomes in screening: how do we do it better?. J. Epidemiol. Community Health
58: 968-970
[Full Text]
Wisnivesky, J. P., Yankelevitz, D., Henschke, C. I.
(2004). The Effect of Tumor Size on Curability of Stage I Non-small Cell Lung Cancers. Chest
126: 761-765
[Abstract][Full Text]
Barratt, A., Trevena, L., Davey, H. M, McCaffery, K.
(2004). Use of decision aids to support informed choices about screening. BMJ
329: 507-510
[Full Text]
Penson, R. T., Daniels, K. J., Lynch, T. J. Jr.
(2004). Too Old to Care?. The Oncologist
9: 343-352
[Abstract][Full Text]
Hsu, R. M., Chan, D. Y., Siegelman, S. S.
(2004). Small Renal Cell Carcinomas: Correlation of Size with Tumor Stage, Nuclear Grade, and Histologic Subtype. Am. J. Roentgenol.
182: 551-557
[Abstract][Full Text]
Sunshine, J. H., Applegate, K. E.
(2004). Technology Assessment for Radiologists. Radiology
230: 309-314
[Abstract][Full Text]
Schwartz, L. M., Woloshin, S., Fowler, F. J. Jr, Welch, H. G.
(2004). Enthusiasm for Cancer Screening in the United States. JAMA
291: 71-78
[Abstract][Full Text]
Kaplan, R. M., Ganiats, T. G., Frosch, D. L.
(2004). Diagnostic and Treatment Decisions in US Healthcare. J Health Psychol
9: 29-40
[Abstract]
Fenton, J. J., Deyo, R. A.
(2003). Patient Self-Referral for Radiologic Screening Tests: Clinical and Ethical Concerns. J Am Board Fam Med
16: 494-501
[Abstract][Full Text]
Clarfield, A. M.
(2003). The Decreasing Prevalence of Reversible Dementias: An Updated Meta-analysis. Arch Intern Med
163: 2219-2229
[Abstract][Full Text]
Mechanic, D.
(2003). Is The Prevalence Of Mental Disorders A Good Measure Of The Need For Services?. Health Aff (Millwood)
22: 8-20
[Abstract][Full Text]
Wisnivesky, J. P., Mushlin, A. I., Sicherman, N., Henschke, C.
(2003). The Cost-Effectiveness of Low-Dose CT Screening for Lung Cancer: Preliminary Results of Baseline Screening. Chest
124: 614-621
[Abstract][Full Text]
Al-Shahi, R., Bhattacharya, J. J., Currie, D. G., Papanastassiou, V., Ritchie, V., Roberts, R. C., Sellar, R. J., Warlow, C. P.
(2003). Prospective, Population-Based Detection of Intracranial Vascular Malformations in Adults: The Scottish Intracranial Vascular Malformation Study (SIVMS). Stroke
34: 1163-1169
[Abstract][Full Text]
Swensen, S. J., Jett, J. R., Hartman, T. E., Midthun, D. E., Sloan, J. A., Sykes, A.-M., Aughenbaugh, G. L., Clemens, M. A.
(2003). Lung Cancer Screening with CT: Mayo Clinic Experience. Radiology
226: 756-761
[Abstract][Full Text]
Blum, J., Rinne, N., Gould, M. K., Chirikos, T. N., Hazelton, T., Tockman, M., Clark, R.
(2003). Lung Cancer Screening Debate. Chest
123: 653-655
[Full Text]
Hoberman, A., Charron, M., Hickey, R. W., Baskin, M., Kearney, D. H., Wald, E. R.
(2003). Imaging Studies after a First Febrile Urinary Tract Infection in Young Children. NEJM
348: 195-202
[Abstract][Full Text]
Gottlieb, R. H., La, T. C., Erturk, E. N., Sotack, J. L., Voci, S. L., Holloway, R. G., Syed, L., Mikityansky, I., Tirkes, A. T., Elmarzouky, R., Zwemer, F. L., Joseph, J. V., Davis, D., DiGrazio, W. J., Messing, E. M.
(2002). CT in Detecting Urinary Tract Calculi: Influence on Patient Imaging and Clinical Outcomes. Radiology
225: 441-449
[Abstract][Full Text]
Black, W. C., Brant-Zawadzki, M. N.
(2002). Invited Commentary * Author's Response. RadioGraphics
22: 1536-1539
[Full Text]
Herman, C. R., Gill, H. K., Eng, J., Fajardo, L. L.
(2002). Screening for Preclinical Disease: Test and Disease Characteristics. Am. J. Roentgenol.
179: 825-831
[Full Text]
Swensen, S. J.
(2002). CT Screening for Lung Cancer. Am. J. Roentgenol.
179: 833-836
[Full Text]
UDAGAWA, T., FERNANDEZ, A., ACHILLES, E.-G., FOLKMAN, J., D'AMATO, R. J.
(2002). Persistence of microscopic human cancers in mice: alterations in the angiogenic balance accompanies loss of tumor dormancy. FASEB J.
16: 1361-1370
[Abstract][Full Text]
Blumenthal, H. T.
(2002). Guest Editorial: The Autopsy in Gerontological Research: A Retrospective. J. Gerontol. A Biol. Sci. Med. Sci.
57: M433-437
[Full Text]
The Evidence-Based Radiology Working Group, T.
(2001). Evidence-based Radiology: A New Approach to the Practice of Radiology. Radiology
220: 566-575
[Abstract][Full Text]
Hobby, J. L., Dixon, A. K., Bearcroft, P. W. P., Tom, B. D. M., Lomas, D. J., Rushton, N., Matthewson, M. H.
(2001). MR Imaging of the Wrist: Effect on Clinical Diagnosis and Patient Care. Radiology
220: 589-593
[Abstract][Full Text]
Obuchowski, N. A., Graham, R. J., Baker, M. E., Powell, K. A.
(2001). Ten Criteria for Effective Screening: Their Application to Multislice CT Screening for Pulmonary and Colorectal Cancers. Am. J. Roentgenol.
176: 1357-1362
[Full Text]
Berlin, L.
(2001). Dot Size, Lead Time, Fallibility, and Impact on Survival: Continuing Controversies in Mammography. Am. J. Roentgenol.
176: 1123-1130
[Full Text]
Jarvik, J. G.
(2001). The Research Framework. Am. J. Roentgenol.
176: 873-878
[Full Text]
Conio, M, Cameron, A J, Romero, Y, Branch, C D, Schleck, C D, Burgart, L J, Zinsmeister, A R, Melton, L J III, Locke, G R III
(2001). Secular trends in the epidemiology and outcome of Barrett's oesophagus in Olmsted County, Minnesota. Gut
48: 304-309
[Abstract][Full Text]
Bolondi, L, Sofia, S, Siringo, S, Gaiani, S, Casali, A, Zironi, G, Piscaglia, F, Gramantieri, L, Zanetti, M, Sherman, M
(2001). Surveillance programme of cirrhotic patients for early diagnosis and treatment of hepatocellular carcinoma: a cost effectiveness analysis. Gut
48: 251-259
[Abstract][Full Text]
Godby, C. J., Peticolas, A., Carter, J. M, Ghebrehewet, S., Woloshin, S., Schwartz, L., Welch, H G., Sox, H. C
(2000). Women's attitudes to false positive mammography results. BMJ
321: 1409-1409
[Full Text]
Black, W. C.
(2000). Anatomic Extent of Disease: A Critical Variable in Reports of Diagnostic Accuracy. Radiology
217: 319-320
[Full Text]
Black, W. C.
(2000). Overdiagnosis: An Underrecognized Cause of Confusion and Harm in Cancer Screening. JNCI J Natl Cancer Inst
92: 1280-1282
[Full Text]
Welch, H. G., Schwartz, L. M., Woloshin, S.
(2000). Are Increasing 5-Year Survival Rates Evidence of Success Against Cancer?. JAMA
283: 2975-2978
[Abstract][Full Text]
Moody-Ayers, S. Y., Wells, C. K., Feinstein, A. R.
(2000). "Benign" Tumors and "Early Detection" in Mammography-Screened Patients of a Natural Cohort With Breast Cancer. Arch Intern Med
160: 1109-1115
[Abstract][Full Text]
Medina, L. S.
(1999). Study Design and Analysis in Neuroradiology: A Practical Approach. Am. J. Neuroradiol.
20: 1584-1596
[Full Text]
Hoberman, A., Wald, E. R., Hickey, R. W., Baskin, M., Charron, M., Majd, M., Kearney, D. H., Reynolds, E. A., Ruley, J., Janosky, J. E.
(1999). Oral Versus Initial Intravenous Therapy for Urinary Tract Infections in Young Febrile Children. Pediatrics
104: 79-86
[Abstract][Full Text]
Black, W. C.
(1999). RESPONSES - Re: Trends in Reported Incidence of Primary Malignant Brain Tumors in Children in the United States. JNCI J Natl Cancer Inst
91: 648a-649a
[Full Text]
Fisher, E. S., Welch, H. G.
(1999). Avoiding the Unintended Consequences of Growth in Medical Care: How Might More Be Worse?. JAMA
281: 446-453
[Abstract][Full Text]
Schwartz, L. M., Woloshin, S., Welch, H. G.
(1999). Risk Communication in Clinical Practice: Putting Cancer in Context. J Natl Cancer Inst Monogr
1999: 124-133
[Abstract][Full Text]
Goodman, D. C., Little, G. A.
(1998). General Pediatrics, Neonatology, and the Law of Diminishing Returns. Pediatrics
102: 396-398
[Full Text]
King, J. T. Jr., Justice, A. C., Aron, D. C.
(1997). Management of Incidental Pituitary Microadenomas: A Cost-Effectiveness Analysis. J. Clin. Endocrinol. Metab.
82: 3625-3632
[Abstract][Full Text]
Black, W. C., Nease, R. F., Welch, H. G.
(1997). Determining Transition Probabilities from Mortality Rates and Autopsy Findings. Med Decis Making
17: 87-93
[Abstract]
Welch, H. G.
(1996). Questions about the Value of Early Intervention. NEJM
334: 1472-1473
[Full Text]
Bauer, T. W.
(1996). Editorial - Identification of Orthopaedic Wear Debris. JBJS
78: 479-81
[Full Text]
Deyo, R. A.
(1994). Magnetic Resonance Imaging of the Lumbar Spine -- Terrific Test or Tar Baby?. NEJM
331: 115-116
[Full Text]
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