Early detection of diseases

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In the early detection of diseases are diseases through medical examination be recognized that not yet been determined, nor yet in any form - by pain have emerged - or discomfort, with deviations from the normal state. Measures for early detection differ from medical preventive care in that they are of a purely diagnostic nature and are therefore not aimed at changing the ascertained physical, mental or emotional state of the person concerned.

Differentiation from the concept of precaution

Under pension (also primary prevention called) refers to measures that are appropriate to prevent the occurrence of diseases (eg. As vaccination , hygiene , accident prevention , smoking cessation , increased physical activity, healthy diet). A classic field of medicine, which almost exclusively with prevention and avoidance of disease is concerned, is the occupational medicine .

Medical early detection measures are sometimes also referred to as “preventive examinations”, which is not only incorrect in technical terms, but also misleading, as, for example, the impression can arise that regular participation prevents the occurrence of cancer (Black et al. 1997). In fact, “cancer prevention” mostly only serves to facilitate an earlier diagnosis, which should enable better treatment. Colon cancer screening using colonoscopy (colonoscopy) is an exception ; Here, if necessary, benign polyps are removed, which would otherwise become malignant in the following years and turn into colon cancer ( adenoma-carcinoma sequence ).

history

The desire for better, more successful treatment methods in the Middle Ages led to knowledge about the origins of diseases. Corresponding studies have been (and are) carried out in many areas. The basic medical sciences experienced an immense upswing, and the discoveries in this area were appropriately honored, as can be seen from the large number of geneticists on the list of Nobel Prize winners in Physiology or Medicine . Terms like epidemiology , medical biochemistry , medical statistics may serve as additional keywords.

Today's possibilities

With this better understanding of diseases, it was no longer necessary to wait for the disease to break out. Today, prenatal diagnostics can be used to detect certain diseases in the unborn child during pregnancy. Whether a child who is growing in the womb of a patient with phenylketonuria will also have this disease and the mother-to-be must therefore stick to her diet plan (strict restriction of protein intake ), for example. B. be found out by an amniocentesis .

However, especially when introducing an examination as a series examination , all advantages and disadvantages of the method as well as the possibilities and limits of the treatability of a disease must be carefully weighed against each other.

On March 1, 2013, the Federal Council finally discussed the Cancer Early Detection and Register Act . In the future, all data on the occurrence, treatment and course of cancer will be recorded in clinical cancer registers, evaluated and reported back to the service providers. The aim is to improve the quality of patient treatment. The new regulation will also expand early cancer detection. Based on the model of organized mammography screening, citizens are to be specifically invited to the early detection of colon cancer and cervical cancer. In addition, quality assurance and monitoring of the success of the cancer screening programs are being expanded.

rating

Medical examinations are characterized by very different levels of invasiveness. In principle, in all medical interventions, the relationship between benefits and dangers must be weighed with the patient. Measuring blood pressure for early detection of arterial hypertension is an example of a risk-free examination. In contrast, the risk of miscarriage is up to 2% with late amniocentesis and up to 5% with chorionic villus sampling .

That early detection extends life and quality of life through more successful therapies sounds plausible, but has only been empirically proven beyond doubt for a few early detection programs . The decline in the disease-related death rate is insufficient as evidence of the benefit, since diagnosis and therapy can promote other causes of death. It can often be shown that people who regularly participate in an early detection program are getting older than the rest of the population; But this could also be due to the fact that these people are generally more health-conscious ( confounding ) . The benefit of early diagnosis examinations is clearly overestimated by the German public. Possible causes are the use of the term “precautionary” ( see above ), the presentation of relative instead of absolute risk reductions and the use of misleading statistical parameters such as the 5-year survival rate: early detection has a positive effect on this parameter, even if the patient is no longer despite previous treatment live, as the interval between diagnosis and death is extended, often beyond five years ( lead-time bias ) . Another statistical bias is the overdiagnosis bias : diseases can only be diagnosed in an early diagnosis examination if the disease has already broken out but does not yet cause any symptoms that would require a doctor to clarify it. In the case of aggressive manifestations of the disease, this time window can be so short that it falls completely within the interval between two early diagnosis examinations. Previously recognized cases therefore have a survival advantage because aggressive courses are underrepresented in their group.

In the classification of findings into normal and pathological , errors inevitably occur due to random variation in the population. The probability with which a sick person is classified as sick is called sensitivity . The probability with which a healthy person is classified as healthy is called specificity . Depending on the definition of the boundary between positive and negative results, one of the two variables can be increased at the expense of the other. Screening tests are applied to a largely healthy population. This results in the problem that even with tests that are both highly sensitive and highly specific, many of those who tested positive come from the group of healthy people. The positive predictive value , i.e. the probability that someone who tested positive is actually ill, is correspondingly low. This usually does not lead to a misdiagnosis, as further diagnosis (e.g. a biopsy ) is carried out to confirm the therapy . The patient would not have had to endure the fear of being sick and the partially invasive confirmatory diagnostics without an early diagnosis examination. Even if the diagnosis is made correctly and therapy is successful, it can be to the detriment of the patient. During early detection, “sick people” are sometimes discovered who would have died for another reason even if left untreated and who may never have had relevant complaints. This phenomenon, known as overdiagnosis , is relevant , for example, in prostate cancer .

In an AOK patient survey, 52 percent of breast cancer screening participants and 75 percent of colorectal cancer colonoscopy cancer screening participants said they had been informed about the benefits of early detection. In terms of disadvantages, however, the rate was only between 25 percent (cervical cancer) and 47 percent (breast cancer). Of the women, 51 percent obtained information on the Internet, only 40 from their family doctor. Among men, 47 percent went online and 50 percent went to their family doctor. The conclusion drawn is that the benefit of early diagnosis examinations is overestimated in the medical profession. In some cases, the evidence on the benefit of preventive care is “very thin”, and false-positive findings for patients often result in “loops in which they are treated unnecessarily”, apart from the psychological stress.

Recommended examinations

In Germany, examinations for the early detection of diseases are anchored in Section 25 and Section 26 of the Fifth Book of the Social Code . The scope of the health examination guidelines of the Federal Joint Committee describe the scope .

According to this, every person with statutory health insurance from the age of 35 has the right to have themselves checked "through their paces" every three years at the expense of the health insurance company. A semi-official name is health check-up . These include not only a history of the whole-body examination ( physical examination ) by the doctor, a blood pressure measurement , a study of blood sugar - and cholesterol levels and a urine test . Conspicuous findings are sent for further diagnostic clarification.

For women from the age of 20 and for men from the age of 45, an examination for early cancer detection is possible annually, which is financed by the statutory health insurance companies.

According to Section 11 of the Occupational Safety and Health Act , all employers must enable their employees to have regular preventive medical examinations based on the assessment of working conditions. The employer bears the costs of these examinations. In addition to the early detection of diseases, these examinations are primarily intended to identify and remedy health hazards at work.

Individual illnesses and examinations

The following list gives an (incomplete) overview of diseases and possible examinations for early detection. It is not a recommendation for examinations to be carried out. For general advantages and disadvantages of screening examinations, see above. Specific advantages and disadvantages are discussed in the respective article.

literature

Black WC, Nease RF Jr. and Tosteson: Perception of Breast cancer risk and screening effectiveness in woman younger than 50 years of age (1995) In: Journal of the National Cancer Institute , 87: 720-731
Rolf Becker, Walter Fuhrmann, Wolfgang Holzgreve u. a .: Prenatal diagnosis and therapy - human genetic counseling, etiology and pathogenesis of malformations, invasive, non-invasive and sonographic diagnosis as well as therapy in utero (1995)
Barbara Maier: Ethics in Gynecology and Obstetrics. Decisions based on clinical case studies , (2000) Verlag Springer ISBN 3-540-67304-0

Web links

Wiktionary: Preventive medical check-up - explanations of meanings, word origins, synonyms, translations

Individual evidence

↑ BSG, judgment of January 22, 1981, 8 / 8a RK 17/79

↑ Archived copy ( memento of the original from December 10, 2017 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. : Press release ( Memento of the original from August 22, 2013 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice.

↑ Gerd Gigerenzer, Jutta Mata, Ronald Frank: Public knowledge of benefits of breast and prostate cancer screening in Europe. In: Journal of the National Cancer Institute . tape 101 , no. 17 , September 2, 2009, pp. 1216-1220 , PMID 19671770 .

↑ The benefit of early diagnosis examinations is overestimated in the medical profession , aend, March 11, 2019, AOK supply report. Retrieved March 11, 2019.

↑ ^a ^b Guideline of the Federal Joint Committee on Health Examinations for the Early Detection of Diseases (Health Examination Guideline). (PDF; 75 KB) Federal Joint Committee, July 19, 2018, accessed on September 1, 2019 (entered into force on October 25, 2018).

^ Karl-Josef Steden: Preventive examinations: The check-up. Prevention Guide 2019: The check-up for women and men. Doctors should increasingly record health risks and stresses. In: Your provision (an initiative of the regional carriers of the German pension insurance and the German pension insurance Knappschaft-Bahn-See). wdv Gesellschaft für Medien & Kommunikation mbH & Co. OHG, January 14, 2019, accessed on September 1, 2019 .

[1] BSG, judgment of January 22, 1981, 8 / 8a RK 17/79