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Predisease: when does it make sense?

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  • 1Department of Family Medicine, 590 Manning Drive, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7595, USA. anthony_viera@med.unc.edu

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Screening identifies "predisease" states, which are intermediate between health and disease. Acting on these states is only beneficial if they predict disease, interventions are effective, and benefits outweigh harms.

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Area of Science:

  • Preventive Medicine
  • Health Screening
  • Disease Progression

Background:

  • Screening often identifies conditions that are neither disease nor entirely healthy, termed "predisease."
  • Examples include precancerous lesions, prediabetes, and prehypertension.
  • The utility of intervening in these "in-between" states is debated.

Purpose of the Study:

  • To evaluate the validity of "predisease" as a clinical category for intervention.
  • To establish criteria for effective "predisease" management.
  • To assess current screening guidelines against these criteria.

Main Methods:

  • Systematic review of screening guidelines (2003-2010) for cervical cancer, glaucoma, diabetes, and hypertension.
  • Analysis of guidelines based on three proposed criteria for "predisease" intervention.
  • Discussion of the framework's applicability to sample conditions.

Main Results:

  • "Predisease" interventions are justifiable only if individuals are at high risk for disease progression.
  • Effective interventions must demonstrably reduce disease likelihood.
  • The benefits of intervention must clearly outweigh potential harms.

Conclusions:

  • Current screening guidelines may not consistently address the criteria for effective "predisease" management.
  • A framework is proposed to evaluate whether interventions on "predisease" states are warranted.
  • Further assessment is needed to ensure screening benefits outweigh harms.