Five prominent Australian healthcare organisations are calling for a national plan to stop overdiagnosis and overtreatment.
They issued a statement outlining how some medical conditions are being diagnosed too often, and that the practice is causing harm.
Overdiagnosis occurs when people are diagnosed with conditions that would not harm them, leading to unnecessary treatments that can cause more harm than good.
One example cited in the statement was thyroid cancer, which they said many people have been diagnosed with and treated for unnecessarily for very small tumours that were in fact benign.
Common overdiagnosed, overtreated, overtested conditions
- Thyroid cancer: 3 fold increase incidence rates from 1982 to 2010
- Prostate cancer: 2 fold increase in incidence rates from 1982-2010
- Breast cancer: 2 fold increase in early breast cancer incidence rates
- Kidney cancer: 2 fold increase in rates from 1982 to 2010
- Gestational diabetes: Previously 5-6pc of pregnant women diagnosed, now 15-20pc in 2013
- ADHD: Prevalence should be around 7pc, more people than that treated with medication
- PCOS: Prevalence of diagnosis peaks in 20-24 year age group, then rapidly decreases, suggests many women may “grow out” of the label by their 30s
Professor Kirsten McCaffery, from the University of Sydney and Wiser Healthcare, said other examples were breast cancer, polycystic ovarian syndrome and ADHD.
Professor McCaffery said increasingly sensitive tests and forms of imaging were finding cancers that have never been found before and treating them.
“If they hadn’t been identified, that person would never have known and gone on happily,” she said.
She said overdiagnosis was causing serious harm to people and their lives.
“Their relationships are broken, their sex lives are destroyed, they give up work — they change their lifestyle entirely because of a label,” she said.
Professor Sanchia Aranda, chief executive of Cancer Council Australia, said while they supported the statement, she rejected any suggestion that breast cancer screening should be scaled back.
“We know breast screening does save lives, so we don’t want to scale back, we want more people to participate,” she said.
“But we need much stronger conversations with women around both the informed consent to do that, but also to understand the results of these diagnosis and whether or not they can afford to have a watchful waiting approach.”
‘Do I really need this test’
Dr Bastian Seidel, president of the Royal Australian College of General Practitioners (RACP), who also supported the statement, said doctors needed to do a “better job.”
“Patients are scared and they’re often fearful, and they’re asking for more tests and they’re asking for more treatment,” he said.
“And of course all it takes for us GPs is to actually sit down and spend more time with our patients to explain the pros and cons of investigation.”
But he said that took time and more funding was needed to allow those longer consultations.
Leanne Wells, from the Consumers Health Forum (CHF), who endorsed the statement, said it was common for people to feel that they had to leave a GPs office with a script.
“This is where we need to educate patients,” she said.
“And they’re just really simple questions to ask the doctor, like do I really need this test, are there simpler safer options?”
The statement also noted that a key driver of the problem of overdiagnosis was the expanding disease definitions and lowering diagnostic thresholds which label more previously healthy people as sick.
The other health organisations in support of the statement were the Royal Australian College of General Practitioners (RACGP), the Royal Australian and New Zealand College of Radiologists (RANZCR) and the Australian Commission on Safety and Quality in Healthcare (ACSQHC).
‘Doctors told me I may never conceive’
Abigail Hatherley has the perfect nuclear family — but she was once unsure if she would ever be able to have children.
When Ms Hatherley was 28, she had an abnormal pap smear and consequently went through a raft of tests. She did not have cancer, but an ultrasound revealed she had polycystic ovaries.
She said her GP told her the diagnosis meant she may never be able to conceive.
“[I was] shocked and horrified, I’d had no symptoms so it was totally news to me,” she said.
18 years ago Abigail Hatherley was unsure if she would ever be able to have children. (Supplied)
“I told my partner at the time and we’d only been seeing for about a year and a half. I have no doubt that news contributed to our inevitable split… that extra pressure [of] ‘Oh my god, we’ve got to start getting serious’.”
The diagnosis left Ms Hatherley feeling depressed and questioning her life choices.
“When you’re 28 and you know you want to have children, that’s a terrible piece of news,” she said.
“At the time it just felt like the world was collapsing around me.”
She later moved to Australia and met her now husband.
They knew they wanted to have children and on medical advice, Ms Hatherley said she stopped taking the pill three months before their wedding.
“The irony of it was as soon as we got married straight away I fell pregnant, we weren’t ready but we thought it would take a really long time,” she said.
“You want to have maybe a couple of years of wedded bliss rather than be thrown in the deep end.”
She conceived easily the second time around also, and said she had text book pregnancies.
While Ms Hatherley acknowledges that her doctor probably wanted to prepare her in case she could not fall pregnant, she thinks she should have been given more information.
“I do feel I would’ve felt much calmer about the whole thing if someone had said ‘you’ve got this but it doesn’t necessarily mean you [won’t be able to have kids], it may make it harder for you to conceive’,” she said.
“[Not] ‘go home, get married, start now’.”