Over di­ag­no­sis also de­tected

Joondalup Weekender - - Opinion - Pro­fes­sor Moira Sim, head of ECU’s School of Medicine

IN health­care, it is widely ac­cepted that early di­ag­no­sis and treat­ment makes good sense be­cause tak­ing timely ac­tion usu­ally means bet­ter out­comes.

How­ever, as tech­nol­ogy ad­vances we are de­vel­op­ing more and more tests that can de­tect prob­lems ear­lier and ear­lier.

What we must re­mem­ber is that as our abil­ity to pick up “prob­lems” in the body in­creases, we may be de­tect­ing dis­eases, such as early and slow-grow­ing can­cers, that were never go­ing to cause a prob­lem in the pa­tient’s life­time.

In th­ese cases, it is pos­si­ble that liv­ing with the di­ag­no­sis, get­ting the side ef­fects of treat­ment or hav­ing treat­ment that is not very ef­fec­tive might be a worse out­come than if the dis­ease went un­de­tected.

We must keep all of this in mind when we talk about screen­ing peo­ple who have no symp­toms for dis­eases.

Be­fore we start to med­dle with an oth­er­wise well pop­u­la­tion, we firstly need to know that the test is ef­fec­tive and that the treat­ment op­tions are go­ing to be ef­fec­tive.

We must con­sider how many lives we are likely to save by the screen­ing, bal­anced against the num­ber of peo­ple who will be harmed by the test­ing or treat­ment.

Fi­nally, we must de­ter­mine if, as a so­ci­ety, we can af­ford the cost of the screen­ing.

An ex­am­ple of pop­u­la­tion screen­ing that is not nec­es­sar­ily lead­ing to bet­ter pa­tient out­comes is the South Korean pro­gram of screen­ing for thy­roid can­cer.

In 2011, they di­ag­nosed around 40,000 cases, more than 100 times greater than the num­ber of peo­ple who died from thy­roid can­cer that year.

It is es­ti­mated that one-third of adults world­wide have small pap­il­lary thy­roid can­cer, the ma­jor­ity of which will not pro­duce symp­toms in the per­son’s life­time.

De­spite this, in South Korea, the ma­jor­ity of those di­ag­nosed un­dergo treat­ment, which can have sig­nif­i­cant side ef­fects.

Ul­ti­mately, the best defence against over di­ag­no­sis is a good, open re­la­tion­ship be­tween the pa­tients and their doc­tor.

We should wel­come the in­creas­ing health lit­er­acy and in­ter­est in the com­mu­nity in shar­ing health de­ci­sions.

We can pro­vide in­for­ma­tion on the pros and cons of test­ing so that peo­ple can make in­formed choices.

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