Overdiagnosis, under-reporting of harms in RCTs

‘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.

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About bmitzi

Medical writer, author, artist. Cancer campaigner. Aiming always to improve health services and bring compassion into health care.
This entry was posted in Breast Cancer, Campaigns, clinical trials, Compassion in healthcare, patient safety, Screening, Screening Mammography and tagged , , , , , , , . Bookmark the permalink.

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