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More overdiagnosis by overdetection

As I am an older guy, nearly 70. I now get constant reminders from my GP and private companies that I should be getting a camera jammed up my arse to check if I have cancer.

No thank you. I have blocked them all.

Stop spending money on early screening diagnosis, it does nothing, and spend the money on treatment for those who need it most..

There is a growing body of evidence that overdiagnosis might even outstrip underdiagnosis and that it comes with its own set of harms.

Consider these scenarios. NHS England estimates that treating cancers found in health screening programmes saves 10,000 lives per year. But what if those very early cancer cells found on screening were never destined to cause serious illness? Not all early cancer cells progress to full-blown cancer.

Perhaps, among this 10,000, some lives were saved but other people were given cancer treatment that wasn’t needed. This is actually a very common example of overdiagnosis by overdetection.

A 2023 study carried out in the US estimated that 31% of breast cancers diagnosed in women over seventy were overdiagnosed.

A French study estimated that more than €100 million was spent on overdiagnosed thyroid cancer in a four-year period.

In many prostate cancer screening programmes no lives are saved but, for every thousand men screened, as many as twenty men are diagnosed with and treated for cancer that would never have caused problems if left alone.

This story is repeated worldwide, for every type of cancer that is subject to screening. Cancer screening programmes save lives but they also risk exposing people to unnecessary invasive medical treatment and to the psychological drawbacks of a cancer diagnosis.

In 2003, the American Diabetes Association adjusted the definition of what it means to have pre-diabetes, lowering the threshold for a normal glucose level in a fasting person from 6.1 millimoles per litre to 5.6.

Were this lowered bar for qualifying as pre-diabetic combined with other tests of glucose intolerance, it could mean as many as half of Chinese adults and a third of British and American adults would be considered to be pre-diabetic if the changes were implemented fully at a global level.

That would place them in a group thought to be at high risk for developing diabetes and make them subject to medical monitoring and potential health anxiety.