Screening test with greatest potential for overdiagnosis?

Screening test with greatest potential for overdiagnosis?

• A. Pap smear
• B. PSA
• C. Mammography
• D. Colonoscopy

Answer: (B)

Overdiagnosis in screening means finding a cancer that would never have caused symptoms or death in a person’s lifetime, so treatment does more harm than good. The PSA test for prostate cancer has the greatest potential for this because many prostate cancers detected by PSA are slow-growing and would not become clinically important. Autopsy studies show a large prevalence of occult prostate cancers in men who died of unrelated causes, confirming that many detected cancers would not have affected quality or length of life. As a result, PSA screening often leads to biopsies, treatments (surgery, radiation, or hormone therapy), and their significant side effects without a clear survival benefit for every man screened. Other screening tests can cause overdiagnosis too, but the balance of indolent disease detected and potential for harm is especially pronounced with PSA.

Overdiagnosis in screening means finding a cancer that would never have caused symptoms or death in a person’s lifetime, so treatment does more harm than good. The PSA test for prostate cancer has the greatest potential for this because many prostate cancers detected by PSA are slow-growing and would not become clinically important. Autopsy studies show a large prevalence of occult prostate cancers in men who died of unrelated causes, confirming that many detected cancers would not have affected quality or length of life. As a result, PSA screening often leads to biopsies, treatments (surgery, radiation, or hormone therapy), and their significant side effects without a clear survival benefit for every man screened. Other screening tests can cause overdiagnosis too, but the balance of indolent disease detected and potential for harm is especially pronounced with PSA.