Part of the TTE office - Carl - is in Oxford, hosting the Preventing Overdiagnosis 2025 International Conference. Session One examined the Incentives, drivers, and mitigation of overdiagnosis and overtreatment, with John Brodersen presenting on the Incentives, causes, mechanisms, and drivers of overdiagnosis.
“Soon we will all be patients,” said John.
During his GP training, he was struck by the emotional impact on patients of having a false positive test result. His career has explored evidence, healthcare communication, and overdiagnosis. As a GP and professor in Copenhagen, John’s research has focused on the psychosocial consequences for healthy people when they are tested.
So, what is overdiagnosis?
‘Broadly, overdiagnosis means making people patients unnecessarily, by identifying problems that were never going to cause harm or by medicalising ordinary life experiences through expanded definitions of diseases.”
What it isn’t: Overdiagnosis is not a false-positive result. False positives are abnormalities that are later determined not to be diseases. Overdiagnosis occurs when an abnormality meets the criteria for a disease but is not likely to cause any symptoms.
As a consequence, nearly one in four cancers detected at screening are overdiagnosed. An analysis of Australian data found that 42% of prostate and renal cancers, 73% of thyroid cancers, and 58% of melanomas were overdiagnosed, totalling 24% of all cancer diagnoses.
Due to the limited effectiveness of new treatments, the industry has shifted its focus to improving health through more rapid and easier access to tests. The current global testing market is worth $250 billion, and it is projected to rise to nearly $500 billion over the next decade. Tests are coming for you. Yet most have no understanding of the accuracy tests, let alone the problem of overdiagnosis.
As for the latest cure for all ills, AI is set to add to the problem. AI tools currently do not save time for most radiologists and may lead to overdiagnosis, warns the president of the UK’s Royal College of Radiologists. The college’s annual workforce census revealed that 56% (62/110) of UK radiology departments using AI reported no change in workload, while 37% (41) said the algorithms had increased it.
With more tech to hand, the industry focus is shifting from "more is better" to "earlier is better." Before you know it, you’ll be locked into the testing movement - confused, befuddled, and overwhelmed. The population will be marketed all sorts of interventions for which they won't derive any benefit, and then they might realise they have been overdiagnosed.
This was written by an old geezer who deplores the rise of
Test test test
The TTE office interviewed John on the role of medical screening in 2017
