‘Austerity, suicide and screening’ is the title of Fiona Godlee’s ‘Editor’s Choice’ this week (BMJ 2013; 347 doi: http://dx.doi.org/10.1136/bmj.f5678 (Published 18 September 2013)
Cite this as: BMJ 2013;347:f5678)
Referring to the Preventing Overdiagnosis Conference in Dartmouth last week (www.preventingoverdiagnosis.net) she says ‘clinicians and academics who had been ploughing a sometimes lonely furrow within their own specialty found themselves at last in like minded company and able to compare notes across healthcare’ (http://bit.ly/1a0oX26).
In particular, she mentions Barnett Kramer who attended the conference and whose editorial focuses on ‘the damage done by indiscriminate use of the term “cancer” for lesions that may not progress’ (doi:10.1136/bmj.f5328).
She also flags up a new study which finds that randomised trials of cancer screening are poor at reporting harms: ‘Of 57 trials identified, only 7% mentioned the risks of overdiagnosis and only 4% recorded false positive results’ (doi:10.1136/bmj.f5334) – ‘familiar concerns’, she adds, for those who have followed the BMJ’s Too Much Medicine campaign (www.bmj.com/too-much-medicine)
When I first heard of ‘overdiagnosis’ I thought it meant being diagnosed in error – eg false positives in breast screening. I did not realise that ‘overtreatment’ usually follows – it seemed too incredible. Yet that is what happens! Because overdiagnosis refers to finding changes that, if left alone, would never have an impact on a person’s health.
The new breast screening leaflet is still inadequate – still plays up the benefits and does not spell out the harms, though subtly done – details later.