This February, the BMJ launched its “Too Much Medicine” campaign and is organising an international conference this September: “Preventing Overdiagnosis” in conjunction with Dartmouth Institute and Bond University. Inspired by, and connected to this movement, GP Julian Treadwell wishes to propose, “Preventing Overdiagnosis and Overtreatment” as a RCGP Clinical Priority for 2014. But there is great competition and he needs more names to support his proposal. If you would like to support this proposal please contact him: firstname.lastname@example.org.
Improved health technologies and research have come hand-in-hand with undesired consequences of overdiagnosis and overtreatment: people have been diagnosed with illnesses that would never have harmed them, or have taken treatments to prevent end point events they were in fact never going to have.
“A tension arises when producing a measurable and significant population level benefit, but a less impressive potential benefit for the individual. For example, treating populations at less than10% risk of CVD with statins could produce a population level benefit, but the Numbers Needed to Treat (NNTs) are very high – conferring a very low potential individual benefit. Similarly, screening mammography in the UK has most recently been estimated to save approximately 1,300 breast cancer deaths a year but has Number Needed to Screen (NNS) of approximately 250 and results in overdiagnosis of approximately 4,000 breast malignancies which would never have caused a problem in the woman’s lifetime.”
Also, if you include deaths from treatment and suicides the benefit of screening for breast cancer dwindles almost out of sight: ‘Harms from breast cancer screening outweigh benefits if death caused by treatment is included’ Baum M. BMJ 2013;346:f385. 23 January 2013. http://www.bmj.com/content/346/bmj.f385