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Kritik der Krebsfrüherkennung

Criticism of cancer screening

  • Leitthema
  • Published:
Der Onkologe Aims and scope

Zusammenfassung

Entgegen der verbreiteten Auffassung, dass Krebsfrüherkennung ohne nennenswerte Risiken sei, besitzt sie ein erhebliches Schadenspotenzial: Neben falsch-negativen und falsch-positiven Befunden sowie der Vorverlegung der Diagnose ohne Heilung sind insbesondere Überdiagnosen problematisch. Dabei handelt es sich um richtig-positive Befunde, die klinisch jedoch nie auffällig geworden wären, wenn man nicht nach ihnen gesucht hätte. Wie die vorliegende Arbeit zeigt, kann als Faustregel für die Häufigkeit von Überdiagnosen gelten: Das Risiko, unnötig zu einem Krebspatienten zu werden, ist mindestens ebenso groß wie die Wahrscheinlichkeit, durch die Untersuchung vor dem Tod durch einen Tumor bewahrt zu werden. Gut belegt ist diese Aussage v. a. für die Früherkennung von Brust- und Prostatakrebs. Informationen über mögliche Schäden müssen in die Aufklärung des Einzelnen und der Bevölkerung einfließen, auch wenn dadurch die Teilnahmeraten möglicherweise zurückgehen.

Abstract

Despite the common belief that cancer screening is without serious risks, it has a significant potential to harm: Besides false positives, false negatives, and advancement of diagnosis without curing cancer or delaying death, the most serious problem is overdiagnosis. Overdiagnosis refers to pathological “true positives” that are not destined to become clinically important. Overdiagnosis is quite frequent: The risk of unnecessarily becoming a cancer patient is at least as high as the chance of not dying from cancer because of screening; good evidence for this relationship exists regarding screening for breast and prostate cancer. Information about potential harm must be given to individuals and the public, even if the participation rate could decrease.

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehung/en hin: Klaus Koch erklärt, dass keine Interessenskonflikte bestehen. Christian Weymayr hat als freier Autor Honorare für Publikationen im Auftrag von Siemens erhalten.

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Authors and Affiliations

  1. Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen (IQWiG), Dillenburger Straße 27, 51105, Köln, Deutschland

    K. Koch

  2. Herne, Herne, Deutschland

    C. Weymayr

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  1. K. Koch
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  2. C. Weymayr
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Correspondence to K. Koch.

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Koch, K., Weymayr, C. Kritik der Krebsfrüherkennung. Onkologe 14, 181–188 (2008). https://doi.org/10.1007/s00761-007-1305-x

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  • DOI: https://doi.org/10.1007/s00761-007-1305-x

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