Analysis

Surge in publications on early detection

BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j2102 (Published 08 May 2017) Cite this as: BMJ 2017;357:j2102
  1. Bjørn Hofmann, professor1,
  2. John-Arne Skolbekken, professor2
  1. 1Department of Health Sciences in Gjøvik, Norwegian University of Science and Technology, Norway
  2. 2Department of Public Health and Nursing, Norwegian University of Science and Technology
  1. Correspondence to B Hofmann b.m.hofmann{at}medisin.uio.no
  • Accepted 28 April 2017

Articles in the medical literature on early detection tend to focus on benefits rather than harms, but does evidence on outcomes warrant this difference ask Bjørn Hofmann and John-Arne Skolbekken

Early detection and treatment of disease have been part of medical practice since the early 19th century. As Chisholm wrote in 1822, “Every chance of success depends on the early detection of disease and, of course, the early adoption of the treatment which experience has proved to be the only one.”1 The opportunity to discover disease in its early development, potentially enabling reductions in morbidity and mortality, has been an incentive for doctors, and, if missed, a source of blame and litigation.2 As lamentably expressed by Arnold in 1907, “The attitude of the general practitioner today toward thoracic aneurysm may be compared to his attitude a few years ago toward the recognition of pulmonary tuberculosis—he was satisfied to recognise the disease when it was fully developed.”3

Since then, early detection of disease has gained considerable attention worldwide, especially in health checks and screening programmes. Improved diagnostic technology, innovations in biomarkers,456 new m-health applications,7 and “P4 medicine” (predictive, preventive, personalised, and participatory)8 have increased this attention. The number of articles on early detection has increased exponentially since the 1970s, and most of these articles have the same message: early detection is a good thing.

More recently, however, this presumption has been challenged. Several types of early detection have been criticised for being ineffective, futile, or even harmful.9 The same goes for health checks.10 The presupposed benefits of early detection can lead to aggressive interventions, the benefits of which are uncertain at best. Early detection can make people ill when it causes “shifts in the perceived severity of the disease, with ripple …

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