Overdiagnosis ‘epidemic’ the target of new alliance of Australian medical professionals
An alliance of doctors, patients, researchers and public organisations is developing a plan to deal with what it describes as an unacceptable level of overdiagnosis in Australia.
An article in the Medical Journal of Australia (MJA) today suggests there are too many unwarranted diagnoses in Australia.
One of the article’s authors, Ray Moynihan, said the evidence suggested it was widespread across many conditions.
“People are being diagnosed because they are at very low risk of some future illness, or have abnormalities that will never go on to cause harm,” he said.
The senior research fellow at Bond University on the Gold Coast said the evidence of overdiagnosis was strongest in the cancer area.
“One of the downsides of screening healthy people is that you will find some cancers that will never cause the patient harm,” Dr Moynihan said.
“In 2016, for example, researchers estimated that more than half a million people, including 10,000 in Australia, may have been overdiagnosed with thyroid cancer over a 20-year period.
“There is strong evidence of overdiagnosis of prostate cancer and some evidence of overdiagnosis of breast cancers.
“There are estimates that perhaps 20 per cent of breast cancers and up to 20, 40 or 50 per cent of prostate cancers detected through screening may be overdiagnosed.”
What to do with results a decision between patient, doctor
The article in the MJA, a publication of the Australian Medical Association, explored how a group convened by the National Cancer Institute in the United States had described overdiagnosis as a modern epidemic.
It said there were concerns across a wide range of conditions including pulmonary embolism, attention deficit hyperactivity disorder (ADHD), and pre-diabetes.
Ray Moynihan contributed to a Medical Journal of Australia article on overdiagnosis in Australia. (Supplied)
The article said there was increasing recognition of the need for some form of coordinated national response to develop evidence-informed strategies that could fairly and safely deal with the problem of overdiagnosis in Australia.
However, at the grassroots level, Royal Australian College of General Practitioners (RACGP) president Harry Nespolon said it was up to the doctor who saw the patient after a screening program to explain the best treatment option.
“It’s what you do with the answers from the screening program,” Dr Nespolon said.
“It’s about explaining the different sorts of treatments and what the consequences are.
“It should always be a joint decision between the patient and the doctor.”
The RACGP president said patients often did not believe they had had a successful consultation unless they were given a piece of paper, or they had been sent off for a test.
“Patients need to understand why they do, or do not, need a test, and whether they need intervention,” he said.
“Patients are becoming more sophisticated. They have extensive access to information, and doctors should be able to help them understand that information in the context of their particular problem.”
Overdiagnosis could lead to overtreatment
Dr Moynihan said in the desire of medical professionals to miss nothing, they were overdiagnosing too many healthy people.
“Doctors don’t want to miss early signs of cancer or disease, and patients don’t want anything to be missed, but overdiagnosis can lead to unnecessary treatments,” he said.
Dr Nespolon said GPs were aware of the importance of not overtreating patients.
“Both doctors and patients need to be educated about what medicine can and can’t do,” he said.
“Patients have very high expectations of the healthcare system.
“They need to understand that just because things are abnormal in a result does not mean something is very wrong with them.”
Medical Journal of Australia’s summary of possible drivers and solutions for overdiagnosis.
(Supplied: Ray Moynihan/Bond University, Medical Journal of Australia)
Dr Moynihan said researchers in Australia and around the world were still trying to work out the magnitude of the problem.
“Surgery can have its own risks, unnecessarily labelling people can lead to anxiety, overdiagnosis threatens the sustainability of the healthcare system, and there’s the possibility of side effects and complications from treatments,” he said.
‘A modern epidemic’
A map of the possible drivers of overdiagnosis and its potential solutions has been developed and was quoted in the MJA.
As one of the report’s authors, Dr Moynihan believed there was a need for national awareness.
“Professional education needs to happen, and the way we evaluate new tests and treatments needs to be strengthened,” he said.
“There’s also the promotion of shared decision-making so people are given more information about the risks and benefits of, for example, screening.”
The MJA article said the Federal Government’s Medicare Benefits Schedule Review Taskforce was developing a series of responses to overdiagnosis, and educational curricula was being developed for students and professionals.
The next international Preventing Overdiagnosis conference is due to be held in Sydney in December next year.