Asymptomatic Meaning

What Does it Mean if a Disease is Asymptomatic?

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What does it mean if a disease is asymptomatic?. Flickr.com/Creative Commons/Raquel Baranow

You may have heard your doctor describe a condition as asymptomatic. What does this mean, when does this occur, and when should you be concerned? Why has there been intense interest in recent years about finding disease when it is still asymptomatic?

Definition: Asymptomatic

The term asymptomatic means literally the absence of symptoms. It describes a condition that is present, but in which a person does not show any outward signs or symptoms of the disease.

 

Examples might include asymptomatic colon cancer in which a person has colon cancer but has not had any change in bowels or bleeding, asymptomatic lung cancer in which a person has not yet developed a cough or shortness of breath or asymptomatic breast cancer in which a breast cancer can be seen on an imaging test (such as mammogram) but has not yet caused a lump or any other symptoms.

An asymptomatic infection may be one in which the bacteria or virus has invaded the body but has not yet caused a fever or any other symptoms. The importance of finding an asymptomatic infection can be illustrated with HIV. If a person tests positive for HIV but does not have any symptoms, we usually describe this as being "HIV positive." When symptoms occur, however, such as opportunistic infections (infections with organisms that do not usually cause disease in people with a healthy immune system) or uncommon cancers, we usually use the term AIDS.

Uses of the Term Asymptomatic in Medicine

Adding confusion to the definition of asymptomatic in medicine, there are two primary ways that the term is used:

  1. When someone has experienced and subsequently recovered from a disease such that they no longer have symptoms they are considered asymptomatic.
  2. When someone has a condition (such as an infection or cancer) but does not yet have any symptoms.

    In contrast, a condition that is present and which has symptoms would instead be called "symptomatic."

    Background

    For most diseases, there is a period of time when the disease is present and asymptomatic before it becomes symptomatic. This is sometimes called the "asymptomatic phase." In fact, the majority of cancer screening tests are designed to detect cancer when it is in this phase—i.e. the cancer is present, but a person does not as yet have any symptoms due to that cancer.

    As noted in this situation of screening, if a condition is asymptomatic, it does not mean that it is not serious. It only means that, at the current time, the disease is not causing any symptoms.

    Significance of an Asymptomatic Condition

    If you have been told you have an asymptomatic illness or condition, don't panic. There are times when this is good information—when treating a disease that has not yet shown any symptoms can make a difference in your long-term health or even survival. Yet there are many times when the discovery of an asymptomatic condition creates unnecessary fear—bringing to light a condition which would never be a problem. In these cases, some might even say "it's better not to know," as treating a condition which would never progress not only doesn't prevent disease in the future but brings on the complications and side effects of whatever treatment is used (not to speak of the emotional implications.)

    Possible Scenarios Involving Asymptomatic Conditions

    An asymptomatic condition could refer to any one of a number of different situations including: 

    • The finding of an asymptomatic condition could be an early sign, which if heeded, could improve your long-term quality of life or survival. An example of this would be the early detection of lung cancer on CT screening. In this example, screening is recommended for people between the ages of 55 and 80, who have smoked for at least 30 pack-years, and continue to smoke or have quit in the past 15 years. In finding early cancers on CT—before any symptoms are present—it’s thought that lung cancer mortality in the United States could be decreased by 20 percent since screening often picks up cancers in the earlier more treatable stages of the disease. Of course, screening may also result in one of the other scenarios below.
    • The asymptomatic finding could be nothing—meaning that early detection will not lead to either an improved quality of life or greater survival—but the need to "work up" the finding may result in emotional turmoil.
    • The asymptomatic finding could be nothing—again meaning that early detection will not lead to either an improved quality of life or greater survival—but the workup needed to evaluate the finding could actually cause more harm that if the finding had not been detected. An example could be the surgical risks related to a biopsy which shows a condition found not to be cancerous.
    • The asymptomatic finding could result in improved survival for some people, but harm for others. An example is the controversy surrounding PSA screening in which testing may result in unnecessary workup and treatment (harm) for some while improving survival for others.
    • The asymptomatic finding could mean different things for different people. An example would be the finding of bacteria in urine tests. In pregnant women or people who have compromised immune systems, awareness of this finding can be advantageous and reduce the risk of serious disease, but for otherwise healthy people could result in unneeded treatment (and the possibility of side effects and adverse reactions to those treatments.)
    • The asymptomatic finding could mean a subclinical infection. An example of this would be a positive strep test in someone without symptoms, or a positive genital herpes test in someone without symptoms (or a positive HIV test.) Being aware of the asymptomatic infection could help reduce the spread of the infection.
    • It may be impossible to know what the asymptomatic test really means for an individual patient. The finding could resolve (go away) or it could progress and cause symptoms.

    Controversy in Screening for Asymptomatic Conditions

    Lately, there has been considerable controversy concerning the use of screening tests, even cancer screening tests. While colon cancer screening, for example, clearly saves lives, it's still not certain whether prostate screening or even breast cancer screening plays a significant role in improving survival (weighing the benefits to some vs risks to others.) Certainly, these screening tests increase the diagnosis of cancer, which is the heart of the current controversy in cancer screening termed overdiagnosis." It's often hard to know whether an asymptomatic condition will progress or will mean nothing. If it will progress, finding the condition can save lives. If it won't, finding the condition may result in overdiagnosis, overtreatment, and the potential risks related to diagnostic procedures and treatments.

    Bottom Line on Asymptomatic Conditions

    Certainly, there are conditions in which treatment of an asymptomatic condition clearly makes a difference, so any asymptomatic finding needs to be carefully and thoroughly discussed with your doctor. That said, it's important that people are aware that not all findings are meaningful. The term often used by medical residents is "red herrings." It's not uncommon to find conditions that are essentially meaningless, but since the condition has been found, a full work-up and potential treatment is then mandated. In being your own advocate in your health care it's imperative to be aware of this emerging problem—the downside of the excellent strides and advances we've made in the diagnosis of disease.

    Pronunciation: A-simp-tow-mat-ick

    Examples: Jaynie said they found her lung cancer early on a CT screening test when it was asymptomatic.

    Sources:

    Saquib, N., Saquib, J., and J. Ionnidis. Does screening for disease save lives in asymptomatic adults? Systematic review of meta-analyses and randomized trials. International Journal of Epidemiology. Published Online First January 15, 2015.

    U.S. National Library of Medicine. Medline Plus. Asymptomatic. Updated 12/10/16. https://medlineplus.gov/ency/article/002217.htm

    U.S. Preventive Task Force. Asymptomatic Bacteriuria in Adults: Screening

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