Giard R W, Coebergh J W
Afd. Klinische Pathologie, St. Clara Ziekenhuis, Rotterdam.
Ned Tijdschr Geneeskd. 1998 Oct 3;142(40):2187-91.
More, earlier and better diagnostic work is being done nowadays, leasing to detection of abnormalities and preliminary stages that used to remain undetected; a large reservoir of subclinical disorders is found to exist. More intensive and sensitive diagnostic methods as a rule lead to higher disease prevalence figures, with the consequences of a seeming increase of disease risk, unnecessary further examinations, treatment and follow-up of individuals and overestimation of the effects of treatment. This may even start a vicious circle. More attention should be given to using diagnostic methods in such a way that the earlier and more frequent detection of disease actually profits the patient. The proof of this should be found in scientific (population) studies of the magnitude and severity of the burden of disease, the determinants of progression, the severity of abnormalities and diseases and the favourable effect of (early) treatment.
如今，诊断工作开展得更多、更早且更好，使得过去未被发现的异常情况和疾病早期阶段得以被检测出来；人们发现存在大量的亚临床疾病。通常，更密集、更敏感的诊断方法会导致更高的疾病患病率，结果看似疾病风险增加，引发不必要的进一步检查、对个体的治疗和随访，以及对治疗效果的高估。这甚至可能引发恶性循环。应该更加注重以这样一种方式使用诊断方法，即更早、更频繁地检测疾病实际上能让患者受益。这一点的证据应来自关于疾病负担的大小和严重程度、病情进展的决定因素、异常情况和疾病的严重程度以及（早期）治疗的有利效果的科学（人群）研究。
