Screening strategy on precision prevention strategies for three types of malignant tumors / 上海预防医学

Malignant tumors can be classified into three categories， rapidly progressing tumors， slowly progressing tumors， and "indolent" tumors. Rapidly progressing tumors （such as liver cancer， pancreatic cancer， and cholangiocarcinoma） have acute onset， shorter time duration from onset to death， and poorer treatment effects， which warrants primary prevention. Slowly progressing tumors （such as lung cancer， colorectal cancer， breast cancer， and gastric cancer） have slow onset， clear precancerous lesions， longer time duration from onset to death， and better therapeutic effects， which is accordingly suitable for secondary prevention. “Indolent” tumors （such as prostate and thyroid cancer） do not affect the life expectancy and are suitable for tertiary prevention. Early screening of “indolent” tumors may lead to overtreatment. Furthermore， early screening of rapidly progressing tumors is difficult to identify early cancers， which results in low cost-effectiveness. In contrast， for slowly progressing tumors suitable for secondary prevention， early screening may have cost-effectiveness， though there might be over-diagnosis. It is crucial to adopt appropriate prevention and treatment strategies for diverse types of tumors. Currently， large-scale cohort studies and randomized controlled clinical trials with complete follow-up may accurately evaluate the effect of cancer prevention strategies. This review discusses the significance of screening in precision prevention of tumors based on the characteristics of tumor progression and patients’ prognosis.

Teratoma quístico maduro con transformación maligna: serie de casos / Cystic teratoma with malignant transformation: Series of cases

Resumen OBJETIVO: Describir las características clínicas e histopatológicas de los casos de teratoma maduro con transformación maligna, su tratamiento y supervivencia. MATERIALES Y MÉTODOS: Estudio retrospectivo, transversal y observacional efectuado entre enero de 2014 y diciembre de 2018 en un servicio de oncología ginecológica. Parámetros de estudio: etapa patológica del tumor, concentraciones de Ca 125, supervivencia y tratamiento. El tamaño de la muestra no permitió aplicar pruebas estadísticas. RESULTADOS: Se estudiaron 147 pacientes con diagnóstico de teratoma maduro, de éstos 4 experimentaron transformación maligna a carcinoma epidermoide y se descartaron 18 por información incompleta. El estudio histopatológico transoperatorio identificó malignidad en 3 de los 4 tumores de ovario. No se practicaron cirugías conservadoras de la fertilidad porque en ninguno de los casos fue necesaria. En 3 de los 4 teratomas maduros con transformación maligna se indicó esquema de quimioterapia coadyuvante. Todas las pacientes permanecen vivas y sin recaída hasta el momento. CONCLUSIONES: El estudio histopatológico transoperatorio es indispensable en todas las lesiones de ovario, incluso las de aspecto quístico. El tratamiento quirúrgico cuidadoso de los tumores malignos de ovario evita su ruptura y cambio en el pronóstico y tratamiento de las pacientes. El tratamiento quirúrgico y médico de una neoplasia poco frecuente, como el teratoma maduro con transformación maligna, mejora la supervivencia y evita subtratamientos o sobretratamientos.

Abstract OBJECTIVE: Describe the clinical and histopathological characteristics of cases of mature teratoma with malignant transformation, its treatment and survival. MATERIALS AND METHODS: Retrospective, cross-sectional and observational study conducted between January 2014 and December 2018 in a gynecological oncology service. Study parameters: pathological stage of the tumor, concentrations of Ca 125, survival and treatment. The sample size did not allow statistical tests to be applied. RESULTS: 147 patients with a diagnosis of mature teratoma were studied of these 4 underwent malignant transformation to squamous cell carcinoma and 18 were ruled out due to incomplete information. The transoperative histopathological study identified 3 of the 4 ovarian tumors as malignant. Fertility conservative surgeries were not performed because in none of the cases was it necessary. In 3 of the 4 mature teratomas with malignant transformation, adjuvant chemotherapy scheme was indicated. All patients remain alive and have no relapse so far. CONCLUSIONS: The histopathological transoperatory study is absolutely necessary for an ovarian tumor, even in cystic ovarian tumors. Carefully management of ovarian tumors is very important, we should prevent a rupture of the malignant tumor because this changes the surgical stage and the prognosis. The surgical and medical treatment of infrequent tumor-like mature teratoma with malignant transformation improves survival and avoid sub treatments or overtreatment.

Prevención cuaternaria: como hacer, como ensiñar / Quaternary prevention: how to do, how to teach / Prevenção quaternária: como fazer, como ensinar

La prevención cuaternaria o P4 se define como las acciones que disminuyen los efectos de las intervenciones innecesarias, generadas por el contacto de las personas con los sistemas de salud. Se planteó como objetivo general desarrollar una estrategia para promover y difundir P4 em Iberoamérica; para cumplir dicha meta se realizó una investigación bibliográfica sobre los conceptos relacionados con P4; se aplicó una encuesta exploratoria para indagar sobre el conocimiento que tenían los participantes en la Cumbre y el Congreso respecto a P4. Existe múltiple literatura que define los términos relacionados con P4, lo que facilita su delimitación. Respecto a la encuesta, de las 309 personas que contestaron; 34% tenían entre 36 y 45 años; 88% eran profesionales en medicina; 69% conocía sobre P4 y más del 50% afirmó estar informado sobre los conceptos relacionados a P4; 92% consideró que P4 no es exclusiva de medicina familiar; 15% aseguró que después de la VI Cumbre se hicieron publicaciones sobre P4 en sus países; menos del 20% consideró que los políticos conocen sobre P4; 27% afirmó que los médicos de familia educan a los pacientes sobre P4. Se recomienda ampliar las campañas de educación sobre P4; facilitar el acceso a la información sobre P4 para profesionales del campo de la salud; incluir P4 en los programas académicos de pregrado y postgrado de las profesiones de la salud; crear alianzas con las entidades políticas de cada país para incluir P4 en políticas públicas.

Quaternary prevention or P4 is defined as any action taken to diminish the effects of unnecessary interventions generated when people interact with a health system. Methodology.The general objective was to develop a strategy to promote and spread P4 in Iberoamerica; to fulfill this goal a literature research was carried out, on the concepts related to P4; an exploratory survey was applied to inquire about the knowledge of the participates in the Summit and Congress, regarding P4 Results. There multiple literature sources that define the terms related to P4, which facilitated its delimitation. Regarding the survey, 69% knew about P4 and more that 50% declared that they where informed about the concepts related to P4; 92% considered that P4 is not only limited to family medicine; 15% assured that after the VI Summit publication regarding P4 where published in their countries; less than 20% stated that politicians knew about P4; 27% affirmed that family medicine doctors educate their patients about P4 Conclusions. It is recommended to expand the educational campaigns about P4; facilitate the access to information about P4 for professionals in the health field; include P4 in the academic programs of health professional for both graduate and post-graduate students; create alliances with political entities of each country to include P4 in public health policies.

A prevenção quaternária ou P4 é definida como ações que reduzem os efeitos de intervenções desnecessárias, geradas pelo contato das pessoas com os sistemas de saúde. O objetivo geral foi desenvolver uma estratégia para promover e disseminar o P4 na Ibero-América; Para atingir este objetivo, foi realizada uma pesquisa bibliográfica sobre os conceitos relacionados a P4; Uma pesquisa exploratória foi aplicada para indagar sobre o conhecimento que os participantes da Cúpula e do Congresso tinham sobre P4. Há uma diversidade de literatura que define os termos relacionados a P4, o que facilita sua delimitação. Em relação à pesquisa, das 309 pessoas que responderam; 34% tinham entre 36 e 45 anos; 88% eram profissionais de medicina; 69% conheciam o P4 e mais de 50% disseram que estavam informados sobre os conceitos relacionados ao P4; 92% consideraram que P4 não é exclusivo de medicina de família; 15% disseram que, após a VI Cúpula, foram feitas publicações sobre P4 em seus países; menos de 20% considerou que os políticos conhecem o P4; 27% disseram que os médicos de família educam os pacientes sobre o P4. Recomenda-se expandir as campanhas de educação sobre P4; facilitar o acesso à informação sobre P4 para profissionais da área da saúde; incluir P4 nos programas acadêmicos de graduação e pós-graduação das profissões de saúde; criar parceiras com as entidades políticas de cada país para incluir P4 nas políticas públicas

Odontología y Ética: sobreoferta y sobreterapia / Dentistry and Ethics: Oversupply and Overtherapy

RESUMEN: Esta revisión está concebida con el propósito de analizar la situación actual de la odontología en Colombia. La revisión se centra en la inoperancia y desregulación del estado sin un modelo planificador sobre la estructura del sistema de salud actual, como causa principal de la sobreoferta profesional, así como del sobretratamiento. Está dividida en dos grandes secciones (orígenes y consecuencias), en los que se busca hacer conexas situaciones concomitantes. En orígenes se trata sobre el tema ético, la realidad desregulatoria e inoperante de los mandos y gremios profesionales, el nivel de evidencia humildemente traducido a la práctica diaria y la necesaria autodeterminación profesional que guie hacia una mejor caracterización entre el paciente saludable y el paciente enfermo, que restrinja el sobretratamiento que está cada vez más cerca a la iatrogenia. En la sección consecuencias, algunos ejemplos de excesos facultativos que se ven reflejados en terapias sin justificación y redundantes que vulneran al paciente. El cambio por un mejor rumbo a futuro debe originarse en la autodeterminación de aquellos objetores de conciencia comprometidos con responsabilidad compartida: El estado Colombiano y sus entes reguladores, los programas académicos que impactan en la conciencia de sus orientados, como el profesional con una meditación íntima y autocrítica que venza los escenariosterapéuticos en contravía del paciente saludable.

ABSTRACT: This review was conceived with the purpose of analysing the current situation of dentistry in Colombia, The review focuses on the inoperability and deregulation of the state without a regulatory model for an actual health system structure as a principal cause of the professional oversupply and over-treatment. It is divided into two major sections (origins and consequences), which seek to make concomitant situations related. In origins, the ethical issue, the deregulatory and inoperative reality of the professional commands and guilds, the level of evidence humbly translated into daily practice and the necessary professional self-determination that guides a better characterization between the healthy patient and the sick patient trying to restricts the over-treatment that is increasingly close to iatrogeny. In consequences section, some facultative excesses examples that are reflected in redundant therapies without justification that victimizes patients. The change for a better course for the future must originate in the selfdetermination of those conscientious objectors committed with shared responsibility: The Colombian state and its regulatory bodies, academic programs that impact on the conscience of its orientated, and the professional with an intimate meditation and self-criticism that overcomes the therapeutic scenarios in wrong way of the healthy patient.

Indispensability of cohort study in tumor prevention and prognosis assessment / 中华预防医学杂志

Cancer is one of the major causes of human death. Early diagnosis and treatment are widely believed to be important in decreasing cancer mortality rate. However, biological factors (such as tumor heterogeneity) and social factors (such as profits driving), over-diagnosis and over-treatment exist in the practice of cancer diagnosis and treatment. The keys to avoid such issues are to identify what kinds of precancerous lesions are more likely to progress into malignant tumors, what kind of early cancer are prone to invading surrounding tissues, and what kinds of prophylactic and therapeutic options are of benefit to effective survival of patients. All above need to be accurately evaluated by cohort studies. Cohort study is the most reliable method to crystallize causal relationship of the exposures (interventions) with the development and recurrence of cancers and define the directions of cancer screening and therapy. Cohort studies shed light on the prediction, screening, and active prophylaxis for the occurrence and recurrence of cancers with specific types. Moreover, the prognostic effects of a given clinical treatment can be precisely evaluated in cohort study, rather than experience-directed clinical activity. Therefore, cohort study is indispensable for cancer research.

Intervención en persona con adicción y que habita en calle / Overtreatment in person with adiction living in the streets

Se presenta el caso de un hombre de 37 años, con consumo dependiente de alcohol, sin redes familiares significativas. Desde hace nueve años, habita en calle. Durante este tiempo ha ingresado a once programas de las redes de apoyo e instituciones y, a pesar de las intervenciones terapéuticas, su cuadro ha empeorado progresivamente. Esta situación ha provocado que el paciente transite por diferentes tratamientos, estableciendo dinámicas de sobre intervención y vínculos de dependencia a los programas donde asiste.

This paper exposes the case of 37 years old man, alcohol dependent, without significant family networks. For 9 years he has been living in the streets, and during this time he has entered in 11 institutions and networks support programs. However, and despite therapeutic interventions, he is progressively worse. Because of this, the person goes through different treatments, leading to overtreatment and dependency bonds with programs he attends.

Control glucémico intensivo y sobretratamiento en pacientes mayores de 60 años con diabetes mellitus / Intensive glycemic control and overtreatment in diabetic patients older than 60 years

Resumen ANTECEDENTES: existe incremento de la prevalência de diabetes mellitus 2 y del envejecimiento. Así, los riesgos asociados con control glucémico intensivo en esta población vulnerable se incrementan. Por ello, debe considerarse la posibilidad de un sobretratamiento en estos pacientes. OBJETIVO: determinar la prevalencia de control glucémico intensivo y sobretratamiento en pacientes con diabetes mellitus tipo 2 mayores de 60 años. MATERIAL Y MÉTODO: estudio retrospectivo, transversal, observacional y analítico. De 2013 a 2015 se evaluaron pacientes mayores de 60 años de edad con diabetes mellitus tipo 2, hemoglobina glucosilada (HbAlc) <7% y administración de hipoglucemiantes. Los pacientes se clasificaron en control glucémico intensivo (HbAlc 6.6-7%) y sobretratamiento (HbAlc <6.5%). Los porcentajes de ambos grupos y sus complicaciones cardiovasculares y no cardiovasculares asociadas se compararon utilizando una prueba Z. RESULTADOS: se incluyeron 13,229 pacientes con diabetes mellitus tipo 2 mayores de 60 años; en 2013, fueron 4,381, 16% (n=701) en control glucémico intensivo y 6% (n=256) en sobretratamiento; en 2014 fueron 4,383, 16% (n=697) en control glucémico intensivo y 6% (n=252) en sobretratamiento; en 2015 fueron 4,465, 16% (n=708) en control glucémico intensivo y 6% (n=260) con sobretratamiento. El control glucémico intensivo causó 5, 3 y 1% de complicaciones durante 2013, 2014 y 2015, respectivamente. En el grupo con sobretratamiento el porcentaje de complicaciones fue de 4% en 2013 y de 6% en 2015. Se obtuvo un valor Z de -2.90 (p<0.05), mostrando mayor número en sobretratamiento. CONCLUSIONES: de la población estudiada, 16% estaba en control glucémico intensivo y 6% en sobretratamiento, con incremento significativo de complicaciones en el grupo con sobretratamiento, la hipoglucemia fue la más frecuente.

Abstract BACKGROUND: Due to increasing prevalence of type 2 diabetes mellitus (T2DM) and the overall aging of the population, the number of elderly patients with T2DM is continuously growing. Given the risks associated with intensive glycemic control of those patients, the possibility of overtreatment must be considered. OBJECTIVE: To determine the prevalence of intensive glycemic control and overtreatment in individuals >60 years with T2DM. MATERIAL AND METHOD: An observational, cross-sectional, retrospective and analytical study was done from 2013 to 2015. Individuals >60 years old with T2DM, glycated hemoglobin (HbA1c) <7%, and use of hypoglycemic agents were included. Patients were divided into two groups: intensive glycemic control (HbA1c 6.6-7%) and overtreatment (HbA1c <6.5%). Cardiovascular and non-cardiovascular complications associated with treatment were compared by Z-test. RESULTS: There were included 13,229 patients older than 60 years with T2DM; 4,381 in 2013, 16% (n=701) was classified as intensive glycemic control and 6% (n=256) as overtreatment; 4,383 in 2014, 16% (n=697) as intensive glycemic control and 6% (n=252) as over-treatment; 4,465 in 2015, 16% (n=708) as intensive glycemic control and 6% (n=260) as overtreatment. By this period, adverse outcomes were reported in 5%, 3% and 1% during 2013, 2014 and 2015, respectively; referring to intensive glycemic control group. Likewise, adverse outcomes were reported in 4% and 6% during 2013 and 2015, respectively; referring to overtreatment group. A value of Z-test -2.90 (p<0.05) was obtained, which was increased in overtreatment group. CONCLUSIONS: All data collected during the study highlights a significant increase of cardiovascular and non-cardiovascular adverse outcomes in patients with strict glycemic management, being hypoglycemia the most frequent; 16% are in intensive glycemic control and 6% in overtreatment.

Ethical Reflection on Interventional Therapy in Patients with Coronary Heart Disease under the Background of the Medical Conjoined in the New Medical Reform / 中国医学伦理学

Due to the development of economy,the mature of technology,and the improvement of institution,the under-treatment and over-treatment of percutaneous coronary intervention (PCI) gradually tends to be balanced in our country.However,these two phenomena still exist in some regions,even in the same hospital.Under the background of the medical conjoined in the new medical reform,it should play its positive role through strengthening the guidanceof medical ethics and the abiding the principle of optimization,in order to apply PCI scientifically and rationally,benefit patients more,and improve the medical quality.

Surgical treatment strategy of gallbladder polyps based on high risk factors of gallbladder cancer / 中华肝胆外科杂志

In order to prevent the canceration of gallbladder polyps or avoid the misdiagnosis of gallbladder cancer,the mainstream practice is cholecystectomy for polyps larger than 1 cm,while gallbladder polyps larger than 0.5 cm as an indication of gallbladder preserving surgery.The reasons for this result is that we put the diameter of more than 1 cm of gallbladder polyps as high risk factors for prediction of gallbladder carcinoma,and we ignored the characteristics of gallbladder polyps that most of them are not gallbladder cancer or are not cancerous even larger than 1 cm.We analysed the high risk factors for gallbladder cancer on the basis of variety of clinical data,and we believe that the most valuable indicator of gallbladder cancer are the growth time of gallbladder polyps,the age of the patients,the combination of gallstones,the single polyps,and the sex.Polyps diameter greater than 1 cm are not a high risk factor for gallbladder cancer.We can use these five high risk factors to manage gallbladder polyps and reduce unnecessary cholecystectomy and gallbladder preserving surgery.

Analysis of the influencing factors for overtreatment in patients with high-grade squamous intraepithelial lesion on primary cervical cytology diagnosis / 中国综合临床

Objective To explore the influencing factors for overtreatment in patients with high-grade squamous intraepithelial lesion(HSIL)on primary cervical cytology diagnosis.Methods Two hundred and thirty-nine patients with initially diagnosed HSIL on cervical cytology and received cervical conization from January 2012 and December 2016 were selected in this study.Overtreatment was defined as he highest level of pathologic diagnosis which was less than or equal to the low-grade squamous intraepithelial lesion(LSIL).The relevance of patients' age,menstrual status,colposcopy finding,the level of high-risk-HPV-DNA and treatment protocol to overtreatment were investigated.Results The most serious pathological diagnosis confirmed that no CIN,LSIL,HSIL,adenocarcinoma in situ(AIS)and squamous carcinoma of cervix(SCC)were detected,with 3.8%(9/239),5.6%(14/239),87.9%(210/239),0.4%(1/239),2.1%(5/239)respectively.The overall overtreatment rate was 9.6%(23/239).The level of high-risk-HPV-DNA and colposcopic findings were significantly related to overtreatment, and colposcopic finding with LSIL was the risk factor for HSIL overtreatment(OR= 8.786,95%CI= 1.671-17.311,P= 0.015),while HPV-DNA≥1000 ng/L was the protective factor(OR=0.201,95%CI=0.043-0.951,P=0.041).Conclusion The level of high-risk-HPV-DNA and the colposcopic finding are the influencing factors for overtreatment in patients with HSIL on primary cervical cytology diagnosis.

Analysis of the influencing factors for overtreatment in patients with high-grade squamous intraepithelial lesion on primary cervical cytology diagnosis / 中国综合临床

Objective To explore the influencing factors for overtreatment in patients with high-grade squamous intraepithelial lesion(HSIL)on primary cervical cytology diagnosis.Methods Two hundred and thirty-nine patients with initially diagnosed HSIL on cervical cytology and received cervical conization from January 2012 and December 2016 were selected in this study.Overtreatment was defined as he highest level of pathologic diagnosis which was less than or equal to the low-grade squamous intraepithelial lesion(LSIL).The relevance of patients' age,menstrual status,colposcopy finding,the level of high-risk-HPV-DNA and treatment protocol to overtreatment were investigated.Results The most serious pathological diagnosis confirmed that no CIN,LSIL,HSIL,adenocarcinoma in situ(AIS)and squamous carcinoma of cervix(SCC)were detected,with 3.8%(9/239),5.6%(14/239),87.9%(210/239),0.4%(1/239),2.1%(5/239)respectively.The overall overtreatment rate was 9.6%(23/239).The level of high-risk-HPV-DNA and colposcopic findings were significantly related to overtreatment, and colposcopic finding with LSIL was the risk factor for HSIL overtreatment(OR= 8.786,95%CI= 1.671-17.311,P= 0.015),while HPV-DNA≥1000 ng/L was the protective factor(OR=0.201,95%CI=0.043-0.951,P=0.041).Conclusion The level of high-risk-HPV-DNA and the colposcopic finding are the influencing factors for overtreatment in patients with HSIL on primary cervical cytology diagnosis.

Awareness, Attitudes and Behaviors of Cervical Cancer Screening in Rural Women with Cervical Erosion and Related Factors Analysis / 沈阳医学院学报

Objective:To analysis awareness,attitudes and behavior conditions of cervical cancer screening in rural women with cervical erosion. Methods:From Mar 25, 2015 to Sep 25, 2015, 700 rural women with cervical erosion were checked-out in reproductive health survey. Self-designed questionnaire was used. Results:Awareness, attitudes, behaviors situation of cervical cancer screening existed some differences in 686 rural women with cervical erosion. Cognition was correlated positively with cultural level, occupation, household income. Awareness of younger or older person was poorer, their attitudes and understanding was positively correlated with the precancerous screening. Conclusions:Awareness of rural women with cervical erosion on cervical cancer screening can affect health attitudes and behavior. So, the strengthening of the awareness of cervical erosion and cervical cancer screening can essentially improve prevention efforts.

"""Overdiagnosis"" and ""overtreatment"" in thyroid cancer" / 中华内分泌代谢杂志

The incidence of thyroid cancer in South Korea increased 15 times over the past twenty years, that made South Korea became a country of the highest reported incidence in thyroid cancer all over the world. But the mortality of thyroid cancer was stable and unchanged. The incidence of thyroid cancer in our country was growing at an annual percentage change of 20. 1%. It is a generally accepted that the sharply increased incidence is attributed tooverdiagnosis. Here we introduced the definition of overdiagnosis of cancer and the current understanding in tumor field. The corresponding strategy in our country was proposed.

History of Korean Thyroid Association and Recent Debates on Diagnosis and Treatment of Thyroid Cancer in Korea / 대한갑상선학회지

It is an undeniable fact that the establishment of the Korean Thyroid Association (KTA) in 2008 will reinforce growing thyroidology in Korea. It is worthwhile to recall the histories behind the foundation of the KTA and to remember the efforts of the founders. Since 2005, there has been a massive increase in thyroid cancer incidence in Korea, which is much higher than in other countries. A large majority of cases fall into papillary microcarcinoma (less than 1 cm). Much debate has been sparked since early 2014 through mass media as well as among medical professionals on the issues of early screening and detection of small thyroid cancer, overdiagnosis and overtreatment of thyroid cancer. Based on the author's past 30 years of clinical practice in endocrinology with a focus on thyroid disease, this article presents my opinion on such debate and provides thoughts on future directions. This article only represents the author's personal, possibly limited, perspective thought. For this reason, readers are recommended to use their own judgement in weighing the opinions.

Analysis on Mechanism of Over-diagnosis and Over-treatment Problem Formation in Public Hospitals of China / 中国卫生经济

According to the theoretical basis of using 5 gripper models of health system reform and high-value policy designing process, to define the over-diagnosis and over-treatment in the process of basic health care utilization in public hospitals of China, basing on the diagnostic framework of the internal and external environment, to explore the causes herein and discriminate the root, direct and intermediate factors that lead to the problem systematically, and identify the formation mechanism of the problem.

Las consecuencias del sobrediagnóstico y el sobretratamiento en el câncer de próstata / The consequences of overdiagnosis and overtreatment in prostate cancer

Introducción. El diagnóstico del cáncer de próstata ha cambiado radicalmente desde que se empezó a usar el antígeno prostático específico. Anteriormente la mayoría de los pacientes eran ancianos que acudían al médico con cánceres avanzados, mientras que en la actualidad la mayoría son varones asintomáticos alertados tras un análisis de sangre de rutina. Muchos de ellos no presentan tumores palpables en el tacto rectal ni visibles en las pruebas radiológicas (T1c), pero a menudo son sometidos a tratamientos agresivos, sin demostrarse mejoría en su supervivencia. Objetivo. Demostrar la existencia del sobrediagnóstico y sobretratamiento en el cáncer de próstata y cuantificar sus consecuencias. Método. Definir los motivos de alarma que justifican la sospecha del sobrediagnóstico y revisar la literatura parajustificarlos. Se presentan los datos que hacen sospechar la presencia de una elevada tasa de sobrediagnóstico entre dichos pacientes.Resultados. No se encuentra bibliografía que enfrente las ventajas de los tratamientos en los casos sospechosos de sobrediagnóstico (T1c). Se resumen las consecuencias manifestadas por los efectos secundarios de las pruebas diagnósticas y los tratamientos en grupos donde más del 80% de los casos son T2, enfrentándolas a los escasos beneficios:para prevenir un muerte hay que revisar como mínimo a 1410 varones y practicar 18,5 prostatectomías. Como efectos indeseables destaca entre los revisados una muerte por cada 9791, una impotencia por cada 58 o una incontinencia por cada 147. Conclusiones. El sobrediagnóstico en el cáncer de próstata en la actualidad es cuantitativamente importante y tienerepercusiones negativas importantes. Por su falta de soporte científico y su generalización más que un simple efecto secundario de una acción médica correcta, está convirtiéndose en un grave error del sistema sanitario en su conjunto.

Introdução. O diagnóstico de câncer de próstata mudou radicalmente desde que começou a ser utilizado o antígeno prostático específico. Antes, a maioria dos pacientes era composta de idosos que procuravam o médico com cânceres avançados, e atualmente a maior parte é constituída de homens assintomáticos alertados por exame de sangue de rotina. Em muitos deles, os tumores não são palpáveis ao toque retal nem visíveis nos exames radiológicos (T1c) e, apesar disso, são amiúde submetidos a tratamentos agressivos, sem demonstração de melhoria nas taxas de supervivência. Objetivo. Demonstrar a existência de sobrediagnóstico e sobretratamento no câncer de próstata e quantificar suasconsequências. Método. Estabelecer os motivos de alarme que justificam a suspeita do sobrediagnóstico do câncer de prostata e revisar a literatura para justificá-los. São apresentados dados que fazem suspeitar que ocorra elevada taxa de sobrediagnóstico nesses pacientes.Resultados. Não se encontram artigos que abordem as vantagens do tratamento nos casos suspeitos de sobrediagnóstico(T1c). São resumidas as conseqüências dos efeitos colaterais dos exames diagnósticos e do tratamento em grupos em que mais de 80% dos casos são T2, confrontando-as aos escassos benefícios: para prevenir uma morte é preciso submeter à biópsia no mínimo 1.410 homens e realizar 18,5 prostatectomias. Como efeitos indesejáveis destacam-se,entre os pacientes submetidos à biópsia, uma morte para cada 9.791, uma impotência para cada 58 ou uma incontinência para cada 147.Conclusões. O sobrediagnóstico no câncer de próstata é quantitativamente importante nos dias atuais e tem repercussõesnegativas importantes. Em virtude da sua generalização e da falta de suporte científico, vem se convertendo não apenas no simples efeito secundário de uma ação médica correta, mas num grave erro do sistema sanitário como um todo.

Introduction. Since the introduction of the specific antigen, the diagnosis of prostate cancer has radically changed. Previously, the majority of those seeking medical assistance were elderly patients with advanced cancers, whereas the current majority are asymptomatic men alerted by a routine blood test. Many tumors are not palpable on digital rectalexamination, nor visible on X-rays (T1c) and yet are often subjected to aggressive treatment, without showing improvement in survival rates.Objective. To demonstrate the existence of overdiagnosis and overtreatment for prostate cancer and to quantify their consequences.Method. Alarming conditions suggesting the occurrence of possible prostate cancer overdiagnosis are described and justified by proper literature review. Data presented give indications of a high rate of overdiagnosis among these patients. Results. No studies have been found that address the benefits of treatment in suspected cases of overdiagnosis (T1c). Summaries are made of consequences of the side effects of diagnostic and treatment groups where more than80% of cases are T2, comparing them to the limited benefits reaped: in order to prevent the death of one patient it is necessary to perform biopsy on at least 1,410 men and to carry out 18.5 prostatectomies. Undesirable effects include one death for every 9,791, one case of impotence for each 58 or one case of incontinence for every 147 patients whounderwent biopsy. Conclusions. The overdiagnosis in prostate cancer is quantitatively important at present and has significant negativeimpacts. Due to the generality of its impact and the lack of scientific support, it is becoming not just a simple side effect of proper medical action, but a serious error of the health system as a whole.

Role of improved primary healthcare compensation for curbing over-treatment / 中华医院管理杂志

Unleashed growth of gross healthcare expenses has emerged a major headache for public administration of countries at large.In China as well,such a rapid growth is incurred mostly by overtreatment due to irrational healthcare compensation.Against this background,it is highly significant to have a brand new insight into over-treatment in China' s viewpoint,and to further study the role of an improved mechanism for primary healthcare compensation for the purpose of curbing over-treatment.These efforts will help improve the primary healthcare service and realize goals of the ongoing health reform.

Medical Ethics Analysis on Different Treatment Plans of Residual Crown And Root / 中国医学伦理学

The residual crown and root has very important physiological significances,but there are many problems in the clinical treatment,such as overtreatment and defensive treatment,etc.This article analyze the background and causes of these problems,and provids some corresponding ways to solve them.

Ethical Reflection on the Over-use of Percutaneous Coronary Intervention / 中国医学伦理学

The problem of over-treatment of percutaneous coronary intervention is expounded in the paper.From the prospective of ethics,several factors such as doctor,patient and even society,all of which can affect the excessive implement of percutaneous coronary intervention,are analyzed in the article.Effective counter-measures to help the development of the technique are also discussed.

Medical Ethics Analysis on Overtreatment in Oral Disease / 中国医学伦理学

Overtreatment is not only an economic phenomenon, but also an ethics problem at the same time. It is precisely a medical - social problem. This paper analyzes the reasons of overtreatment in oral disease from the view of medical elthics. Furthermore, it provides the strategy which the doctor, the patient, the medical establishment and the social shoud be adopted on overtreatment in oral disease.