Many pathologists agree overdiagnosis of skin cancer happens, but don’t change diagnosis behavior – Washington, District of Columbia
Washington, District of Columbia 2022-05-03 12:42:22 –
May 3, 2022
Skin pathologists told researchers that they saw cases that shouldn’t have been biopsied in the first place and pointed out overdiagnosis as a problem that might be rooted in too many skin biopsies.Peak stock / Shutterstock
As the most serious type of skin cancer, the diagnosis of melanoma has emotional, economic, and medical consequences. That is why recent studies that have found that there is overdiagnosis of melanoma are an important cause of concern.
“Overdiagnosis is the diagnosis of a disease that does not harm a person in a lifetime. If melanoma is overdiagnosed, it means that too many people receive the horrifying news that they have cancer. It means that you are paying for unnecessary treatment. ” Kathleen CarrProfessor of Biostatistics at UW School of Public Health.
Car recently Published results As a result of a study involving more than 100 skin pathologists (pathologists who specialize in skin diseases and diagnose melanoma), whether they believe that overdiagnosis of melanoma is a public health problem in the United States, and its We investigated whether beliefs influence their own conclusions. Pathologists were given biopsy slides for diagnosis and investigated the perception of overdiagnosis.
Kerr discussed the results of this study, published at JAMA Dermatology on April 20, in the next Q & A with UW News.
How can I tell if my illness is overdiagnosed?
Kathleen Carr: Overdiagnosis is often studied by examining population-level data rather than individual cases. Diagnosis of melanoma is increasing in the United States. If there was a true melanoma epidemic, there was no significant progress in treatment during this period, and melanoma deaths are expected to show a corresponding increase. Still, death from melanoma is very constant. This suggests that the increased diagnosis of melanoma is primarily due to overdiagnosis.
Why does this happen with melanoma?
car: The problem is multifaceted. Most of us who are not doctors think that there is a possibility of cancer in the skin, and if it is biopsied, the pathologist’s diagnosis after examining the skin tissue under a microscope is decisive. .. The reality is more complicated.
Skin abnormalities are some of the most difficult cases for pathologists to diagnose. Previous studies have shown that different pathologists testing the same skin biopsy can make very surprisingly different diagnoses. When the same pathologist examines the same case on two different occasions, it can even make two substantially different diagnoses.
Advanced melanoma is fairly easy for pathologists to diagnose, but difficulties arise when the biopsy does not appear to be melanoma but shows certain abnormalities that may be a precursor to melanoma. increase. These are the cases where pathologists show the most variability in diagnosis and increase the likelihood of overdiagnosis.
What did you find in your research?
car: The first component of our recent paper was a survey of practical skin pathologists’ perceptions of overdiagnosis. About half recognize that non-invasive melanoma is overdiagnosed, and one-third recognize that invasive melanoma is overdiagnosed. Also, the majority of skin pathologists agree to see cases that should not have been biopsied in the first place. This indicates overdiagnosis as a system-wide problem. This is a problem that may be due to too many skin biopsies.
The second element of our study was to look for a link between pathologists’ perceptions of overdiagnosis and how they diagnosed an actual skin biopsy.Who thought Infiltrative melanoma If you have been overdiagnosed, you may need to make more appointments to make this diagnosis, but this was not true.In fact, few thought that invasive melanoma was overdiagnosed. more Compared to other cutaneous pathologists looking at the same case, it is more likely to diagnose invasive melanoma.
What do you think is the importance of this discovery?
car: Overdiagnosis is a very difficult problem, as both doctors and patients are wary of missing cancer. This is understandable. Our study shows that overdiagnosis of melanoma is widely recognized among skin pathologists. It also shows that awareness of overdiagnosis may not be sufficient to reduce overdiagnosis. Not surprisingly, there is no easy solution to such a complex problem. To reduce overdiagnosis, it is necessary to involve patients and primary care physicians who are more restrained from obtaining skin biopsies, and pathologists who exercise restraint when diagnosing cases as melanoma.
Co-authors are Megan Eguchi and Joann Elmore of David Geffen School of Medicine, University of California, Los Angeles. Michael Piepkorn, Washington School of Medicine, Department of Skin Pathology, Department of Skin Pathology, Northwest Bellevue. Andrea Radick, Lisa Reish, Hannah Schcard, University of Washington School of Public Health Biostatistics. Stevan Knezevich, Pathology Associates, California; Raymond Barnhill, Institut Curie, Paris Sciences and Lettres Research University, University of Paris, France; David Elder, Department of Pathology and Clinical Laboratory Medicine, University of Pennsylvania Hospital. This study was funded by the National Institutes of Health.
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Contact Kerr for more information. katiek@uw.edu..
tag: Department of Biostatistics •• Kathleen Carr •• Faculty of Public Health
Many pathologists agree overdiagnosis of skin cancer happens, but don’t change diagnosis behavior Source link Many pathologists agree overdiagnosis of skin cancer happens, but don’t change diagnosis behavior
