142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

State of the Science Update: Preventive screening, false positives and “overdiagnosis.”

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Monday, November 17, 2014 : 8:30 AM - 8:45 AM

Maria Gilson deValpine, RN MSN PhD , Department of Nursing, James Madison University, Harrisonburg, VA
Patty Hale, RN FAAN PhD , Department of Nursing, James Madison University, Harrisonburg, VA
Background and issues: Preventive screening rests on a tightly held epidemiologic assumption that early disease detection saves lives and improves quality of life. A more complicated picture, however, arises from recent re-analyses of screening data. Providers are often reluctant to adopt screening recommendations based on new evidence; and patients demand screening tests, failing to understand absolute versus relative risk, and affirmed in their beliefs through health promotion and media messages. 

Description: Recent re-analyses of breast, prostate, and cervical cancer screening data were reviewed.  Current recommendations, screening practices, and provider and patient “uptake” of new recommendations were explored in the research literature.

Lessons-learned: Recent re-analyses of large-scale preventive screening program data indicate substantial “overdiagnosis” of disease. Mammography screening, for example, results in substantial false positive tests, leading to life-changing treatment for non-trivial numbers of women. Similarly, prostate surface antigen screening of asymptomatic men results in frequent treatment--with significant complications--of non-progressive disease. Widespread screening of “well” people may result in substantial harm for small numbers of lives saved as well as psychological and sociologic consequences of disease diagnoses. The cost of false positives evokes a re-examination of risk assessment and recommendations for preventive screening.

Learning Areas:

Conduct evaluation related to programs, research, and other areas of practice

Learning Objectives:
Discuss absolute versus relative risk in relationship to preventive screening tests Describe the outcomes of recent reanalyses of mammography and PSA screening data Evaluate early detection and treatment assumptions in light of new data

Keyword(s): Evidence-Based Practice, Epidemiology

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I did the literature review and analysis of the secondary data for this abstract.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.