Overdiagnosis and the dangers of early detectionBMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d1140 (Published 23 February 2011) Cite this as: BMJ 2011;342:d1140
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Re Overdiagnosis and the dangers of early detection.
In his review of "Over-diagnosed: Making People Sick in the Pursuit
of Health" Ray Moynihan presents a powerful case for making clearer
information available to people, but it is not just "financial ties to
drug makers" that are a barrier to "the truth of the uncertainties around
early detection and the potential harms of unnecessary treatment."
The most blatant example of inadequate information about
overdiagnosis and consequent overtreatment (1) is the NHS Breast Screening
leaflet which says opaquely "screening can find cancers which are treated
but which may not otherwise have been found during your lifetime." (2)
Compare this with NHS Screening's comments on the limitations of PSA
testing "48 men will undergo treatment in order to save one life". The
grave side-effects of treatment are fully spelled out.
Why the disparity?
Don't women deserve honest information?
The conflict of interest seen in breast cancer screening (4) appears
to be treatment-resistant.
Consent for screening is only valid if it based on understanding.
Women deserve to be fully informed and not misled (5).
1) McPherson K. BMJ 2011; 342:d791 doi: 10.1136/bmj.d791 (Published 8
4) Jorgensen KJ, Goetzsche PC, Content of invitations for publicly
funded screening mammography. BMJ 2006;332: 538-41.
5) Baines CJ. Mammography screening: are women really giving informed
consent? J Natl Cancer Inst 2003;95:1508-1511.
Competing interests: No competing interests