[A critical view on cancer screening: do we see the elephant in the room?].

Cancer screening promises health benefits but it also delivers harms and costs. A substantial problem is overdiagnosis of tumors not needing treatment. There are well established principles for starting cancer screening, but we also need periodical evaluations and stopping rules.

Predictors for neoplastic progression in patients with Barrett's Esophagus: a prospective cohort study.

Objectives: Patients with Barrett's esophagus (BE) have an increased risk of developing esophageal adenocarcinoma (EAC). As the absolute risk remains low, there is a need for predictors of neoplastic progression to tailor more individualized surveillance programs. The aim of this study was to identify such predictors of progression to high-grade dysplasia (HGD) and EAC in patients with BE after 4 years of surveillance and to develop a prediction model based on these factors.

[Sterile gloves are not necessary in minor surgery].

According to the practice guideline of the Dutch Workingparty on Infection Prevention (WIP) sterile gloves have to be worn during minor surgery by the general practitioner. This is based on the microbiological principles of Spaulding and is not supported by other evidence. Current literature suggests that using clean, nonsterile gloves, instead of sterile gloves, does not result in a greater risk of wound infection in primary closed wounds after minor surgery.

[Diagnosis of breast cancer missed in a young woman].

The diagnosis of breast cancer in a 31-year-old woman was delayed, apparently because she did not comply with advice to come for a follow-up appointment after an initial diagnosis of adenofibroma. For this she held her general practitioner (GP) responsible. In the ensuing legal battle the court expert testified that the GP had complied with the appropriate practice guideline.

When is the practice of pathology malpractice?

Because of its complex nature, surgical pathology diagnosis has an appreciable degree of fallibility and is increasingly subject to legal scrutiny. In litigation, the first practical step is to explain why and how this adversity could happen, and the second is the question of apportionment of responsibility and its legal consequences. As pathologists, we have to provide a methodology of investigation allowing a clear distinction between reasonable and unacceptable pathology practice without the twist of hindsight.