Scrutiny-Dependent Cancer and Self-fulfilling Risk Factors
Authors: H. Gilbert Welch, Otis W. Brawley
Journal: Annals of Internal Medicine (2018)

Ideas and Opinions16 January 2018Scrutiny-Dependent Cancer and Self-fulfilling Risk FactorsH. Gilbert Welch, MD, MPH and Otis W. Brawley, MDH. Gilbert Welch, MD, MPHThe Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire (H.G.W.) and Otis W. Brawley, MDAmerican Cancer Society, Atlanta, Georgia (O.W.B.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M17-2792 Annals Author Insight Video - H. Gilbert Welch, MD, MPH In this video, H. Gilbert Welch, MD, MPH, offers additional insight into the article, "Scrutiny-Dependent Cancer and Self-fulfilling Risk Factors." SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Physicists have long understood that the act of observation can affect the phenomenon being observed. Measuring pressure reduces the air pressure in an automobile tire; measuring voltage reduces the amount of voltage in a circuit. Physicians would do well to understand how the act of observation can affect the apparent incidence of cancer—as well as apparent risk factors for this disease.That the number of cases of cancer diagnosed is sensitive to the degree of scrutiny is a familiar fact in prostate cancer. Consider the remarkable volatility in the reported incidence of prostate cancer in the United States over the ...References1. Tangen CM, Goodman PJ, Till C, Schenk JM, Lucia MS, Thompson IM. Biases in recommendations for and acceptance of prostate biopsy significantly affect assessment of prostate cancer risk factors: results from two large Randomized clinical trials. J Clin Oncol. 2016;34:4338-44. [PMID: 27998216] CrossrefMedlineGoogle Scholar2. Albertsen PC. Risk factors for prostate cancer: which are truly predictive of clinically significant disease? J Clin Oncol. 2016;34:4310-1. [PMID: 27998221] CrossrefMedlineGoogle Scholar3. Berwick M, Armstrong BK, Ben-Porat L, Fine J, Kricker A, Eberle C, et al. Sun exposure and mortality from melanoma. J Natl Cancer Inst. 2005;97:195-9. [PMID: 15687362] CrossrefMedlineGoogle Scholar4. Hayse B, Hooley RJ, Killelea BK, Horowitz NR, Chagpar AB, Lannin DR. Breast cancer biology varies by method of detection and may contribute to overdiagnosis. Surgery. 2016;160:454-62. [PMID: 27241117] doi:10.1016/j.surg.2016.03.031 CrossrefMedlineGoogle Scholar5. Conroy SM, Shariff-Marco S, Koo J, Yang J, Keegan TH, Sangaramoorthy M, et al. Racial/ethnic differences in the impact of neighborhood social and built environment on breast cancer risk: the Neighborhoods and Breast Cancer Study. Cancer Epidemiol Biomarkers Prev. 2017;26:541-52. [PMID: 28196846] doi:10.1158/1055-9965.EPI-16-0935 CrossrefMedlineGoogle Scholar6. Welch HG, Black WC. Overdiagnosis in cancer. J Natl Cancer Inst. 2010;102:605-13. [PMID: 20413742] doi:10.1093/jnci/djq099 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: The Dartmouth Institute for Health Policy and Clinical Practice, Hanover, New Hampshire (H.G.W.)American Cancer Society, Atlanta, Georgia (O.W.B.)Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-2792.Corresponding Author: H. Gilbert Welch, MD, MPH, Tuck 203B, Dartmouth College, Hanover, NH 03755; e-mail, h.gilbert.[email protected]edu.Current Author Addresses: Dr. Welch: Tuck 203B, Dartmouth College, Hanover, NH 03755.Dr. Brawley: American Cancer Society, 250 Williams Street, Suite 600, Atlanta, GA 30303.Author Contributions: Conception and design: H.G. Welch.Drafting of the article: H.G. Welch, O.W. Brawley.Critical revision of the article for important intellectual content: O.W. Brawley.Final approval of the article: H.G. Welch, O.W. Brawley.Statistical expertise: O.W. Brawley.Collection and assembly of data: O.W. Brawley.This article was published at Annals.org on 2 January 2018. PreviousarticleNextarticle Advertisement Annals Author Insight Video - H. Gilbert Welch, MD, MPH In this video, H. Gilbert Welch, MD, MPH, offers additional insight into the article, "Scrutiny-Dependent Cancer and Self-fulfilling Risk Factors." FiguresReferencesRelatedDetailsSee AlsoScrutiny-Dependent Cancer and Self-fulfilling Risk Factors H. Gilbert Welch and Otis W. Brawley Scrutiny-Dependent Cancer and Self-fulfilling Risk Factors Roberto Zanetti , Lidia Sacchetto , and Stefano Rosso Metrics Cited byThe European cancer burden in 2020: Incidence and mortality estimates for 40 countries and 25 major cancersSkin melanoma deaths within 1 or 3 years from diagnosis in EuropeA Latent Disease Model to Reduce Detection Bias in Cancer Risk Prediction StudiesRisk of invasive prostate cancer and prostate cancer death in relatives of patients with prostatic borderline or in situ neoplasia: A nationwide cohort studyRacial Disparities in Cancer Presentation and Outcomes: The Contribution of OverdiagnosisEpidemiologic Signatures in CancerProstate cancer incidence and mortality in the Baltic states, Belarus, the Russian Federation and UkraineFuture of cancer incidence in Shanghai, China: Predicting the burden upon the ageing populationCutaneous nevi and risk of melanoma death in women and men: A prospective studyAssociation Between Health Maintenance Practices and Skin Cancer Risk as a Possible Source of Detection BiasTrends in and Predictions of Colorectal Cancer Incidence and Mortality in China From 1990 to 2025Cancer incidence and mortality patterns in Europe: Estimates for 40 countries and 25 major cancers in 2018To accelerate cancer prevention in Europe: Challenges for cancer registriesScrutiny-Dependent Cancer and Self-fulfilling Risk FactorsRoberto Zanetti, MD, PhD, Lidia Sacchetto, MSc, and Stefano Rosso, MDGenomic Screening: The Mutation and the Mustard Seed 16 January 2018Volume 168, Issue 2Page: 143-144KeywordsBreast cancerCancer detection and diagnosisCancer risk factorsCancer screeningMedical risk factorsMelanomaProstate cancerSocioeconomic statusThyroidThyroid carcinoma ePublished: 2 January 2018 Issue Published: 16 January 2018 Copyright & PermissionsCopyright © 2018 by American College of Physicians. 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