Over diagnosis also detected
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.