Few told about overdiagnosis from prostate cancer screening

Fewer than 10% of patients are being told about the possibility of overdiagnosis and overtreatment as a result of screening for prostate and other cancers, according to findings from a recently published survey.

The online survey of 317 U.S. men and women ages 50 to 69 years was designed to determine how many patients had been informed of overdiagnosis and overtreatment by their physicians and how much overdiagnosis they would tolerate when deciding whether to start or continue screening. PSA testing and colonoscopy/sigmoidoscopy testing were the most common cancer screenings reported by men.

Of the group, 9.5% of study participants reported their physicians had told them about the possibility of overdiagnosis and overtreatment, Odette Wegwarth, PhD, and Gerd Gigerenzer, PhD, of the Max Planck Institute for Human Development in Berlin reported in a research letter online in JAMA Internal Medicine (Oct. 21, 2013). The percentage of participants indicating they were informed of overtreatment risk by their physician was slightly higher among male versus female participants (10.6% vs. 8.4%, respectively).

About half (51%) of the participants reported that they were unprepared to start a screening that results in more than one overtreated person per one life saved from cancer death. However, nearly 59% reported that they would continue the cancer screening they receive regularly even if they learned that the test results in 10 overtreated people per one life saved from cancer death.

“The results of the present study indicate that physicians’ counseling on screening does not meet patients’ standards,” the authors wrote.

“The large number of uninformed patients might be explained by a large number of physicians who themselves know little about screening harms,” they added, citing a study of 412 U.S. primary care physicians that showed only 42.9% and 33.9%, respectively, were able to provide a correct estimate about the extent of overdiagnosis for PSA testing and mammography screening (Ann Intern Med 2012; 156:340-9).

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