What Is Disease and When Does It Begin?

  • Robert M. Kaplan

A close friend recently shared her reaction to being diagnosed with cancer. The diagnosis occurred 11 years ago, but her memories are vivid. “I can remember the day my doctor told me I had cancer,” she said. “That was the day my life changed. Before that, I had been completely healthy.”

My friend talked as though her cancer began the day her doctor told her about it. But is that really when the disease started? Most likely, the disease had been developing for years before the diagnosis. In this chapter, we will explore a variety of misperceptions about chronic disease. These misperceptions of chronic illness are common and may have a profound effect on how we make decisions about treatment, how resources in healthcare are spent, and why we often neglect to look in the right place for resolutions to health problems.

Common Perceptions of Chronic Disease

Beliefs about chronic illness influence decisions about screening, treatment, and health habits. A variety of common beliefs about the...


Breast Cancer Prostate Cancer Coronary Artery Bypass Graft Heart Attack American Patient 
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  1. 1.
    Black WC. Overdiagnosis: an underrecognized cause of confusion and harm in cancer screening. J Natl Cancer Inst.Aug 16 2000;92(16):1280–1282.CrossRefGoogle Scholar
  2. 2.
    Welch HG, Black WC. Using autopsy series to estimate the disease "reservoir" for ductal carcinoma in situ of the breast: how much more breast cancer can we find? Ann Intern Med.1997;127(11):1023–1028.Google Scholar
  3. 3.
    Black WC, Welch HG. Screening for disease. AJR Am J Roentgenol.1997;168(1):3–11.Google Scholar
  4. 4.
    Welch HG, Woloshin S, Schwartz LM. Skin biopsy rates and incidence of melanoma: population based ecological study. BMJ.Sep 3 2005;331(7515):481.Google Scholar
  5. 5.
    Sakr WA, Grignon DJ, Haas GP, Heilbrun LK, Pontes JE, Crissman JD. Age and racial distribution of prostatic intraepithelial neoplasia. Eur Urol.1996;30(2):138–144.Google Scholar
  6. 6.
    Stamey TA, Caldwell M, McNeal JE, Nolley R, Hemenez M, Downs J. The prostate specific antigen era in the United States is over for prostate cancer: what happened in the last 20 years? J Urol.Oct 2004;172(4 Pt 1):1297–1301.CrossRefGoogle Scholar
  7. 7.
    Pepine CJ, et al. A definition of advanced types of atherosclerotic lesions and a histological classification of atherosclerosis. Am. J. Cardiol. 1998; 82:10 (Supplement): 235–278.Google Scholar
  8. 8.
    Stary HC, Chandler AB, Dinsmore RE, et al. A definition of advanced types of atherosclerotic lesions and a histological classification of atherosclerosis. A report from the Committee on Vascular Lesions of the Council on Arteriosclerosis, American Heart Association. Circulation.Sep 1 1995;92(5):1355–1374.Google Scholar
  9. 9.
    Enos WF, Jr., Beyer JC, Holmes RH. Pathogenesis of coronary disease in American soldiers killed in Korea. J Am Med Assoc.Jul 16 1955;158(11):912–914.Google Scholar
  10. 10.
    McNamara JJ, Molot MA, Stremple JF, Cutting RT. Coronary artery disease in combat casualties in Vietnam. JAMA.May 17 1971;216(7):1185–1187.CrossRefGoogle Scholar
  11. 11.
    Strong JP, Malcom GT, McMahan CA, et al. Prevalence and extent of atherosclerosis in adolescents and young adults: implications for prevention from the Pathobiological Determinants of Atherosclerosis in Youth Study. JAMA.Feb 24 1999;281(8):727–735.Google Scholar
  12. 12.
    McGill HC, Jr., McMahan CA, Zieske AW, et al. Association of Coronary Heart Disease Risk Factors with microscopic qualities of coronary atherosclerosis in youth. Circulation.Jul 25 2000;102(4):374–379.Google Scholar
  13. 13.
    Tuzcu EM, Kapadia SR, Tutar E, et al. High prevalence of coronary atherosclerosis in asymptomatic teenagers and young adults: evidence from intravascular ultrasound. Circulation.Jun 5 2001;103(22):2705–2710.Google Scholar
  14. 14.
    Armenian HK, Lilienfeld AM. Incubation period of disease. Epidemiol Rev.1983;5:1–15.Google Scholar
  15. 15.
    Armenian HK, Lilienfeld AM. The distribution of incubation periods of neoplastic diseases. Am J Epidemiol.Feb 1974;99(2):92–100.Google Scholar
  16. 16.
    Terry PD, Miller AB, Rohan TE. Cigarette smoking and breast cancer risk: a long latency period? Int J Cancer.Aug 20 2002;100(6):723–728.Google Scholar
  17. 17.
    Nicod P, Gilpin EA, Dittrich H, et al. Trends in use of coronary angiography in subacute phase of myocardial infarction. Circulation.Sep 1991;84(3):1004–1015.Google Scholar
  18. 18.
    Wennberg JE. The Dartmouth Atlas of Health Care in the United States. Hanover, NH: Trustees of Dartmouth College; 1998.Google Scholar
  19. 19.
    Tu JV, Pashos CL, Naylor CD, et al. Use of cardiac procedures and outcomes in elderly patients with myocardial infarction in the United States and Canada. N Engl J Med.May 22 1997;336(21):1500–1505.CrossRefGoogle Scholar
  20. 20.
    Fisher ES, Wennberg DE, Stukel TA, Gottlieb DJ, Lucas FL, Pinder EL. The implications of regional variations in Medicare spending. Part 2: health outcomes and satisfaction with care. Ann Intern Med.Feb 18 2003;138(4):288–298.Google Scholar
  21. 21.
    Fisher ES, Wennberg DE, Stukel TA, Gottlieb DJ, Lucas FL, Pinder EL. The implications of regional variations in Medicare spending. Part 1: the content, quality, and accessibility of care. Ann Intern Med.Feb 18 2003;138(4):273–287.Google Scholar
  22. 22.
    Welch HG. Should I Be Tested for Cancer ? Berkeley, CA: Universlty of California Press; 2004.Google Scholar
  23. 23.
    Kaplan RM. Screening for cancer: are resources being used wisely? Recent Results Cancer Res.2005;166:315–334.CrossRefGoogle Scholar
  24. 24.
    Mosca L, Arnett DK, Dracup K, et al. Task force on strategic research direction: population/outcomes/epidemiology/social science subgroup key science topics report. Circulation.Nov 12 2002;106(20):e167–172.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Robert M. Kaplan
    • 1
  1. 1.UCLA School of Public HealthLos AngelesUSA

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