Early Disease Detection Not Always Advantageous

Medical technology can today discover conditions and precursors of disease for which the treatment itself can be more traumatic than living with the ailment.

Researchers at the Norwegian University of Science and Technology (NTNU; Trondheim, Norway) conducted a review of research literature dealing with early detection of diseases from the 19th century to the present. They found that 30 times as many articles about early detection are published today as in the 1950s, even when taking into account that the total number of publications has increased. But for each article that looks at both the pros and cons of early detection, 76 articles deal with only one side of the issue, or do not discuss it at all.

In fact, most research articles look only at the beneficial aspects of early detection, and do not mention harms at all. Health checks and screening programs, improved diagnostic technology, innovations in biomarkers, new m-health applications, and so called P4 (predictive, preventive, personalized, and participatory) medicine have increased this attention, with most articles sending the same message: early detection is a good thing. But the researchers warn that there needs to be a better balance in the information provided about the pros and cons of early detection.

For example, they cite the Norwegian Directorate of Health, which recently decided that all pregnant women should be tested for gestational diabetes using a comprehensive and resource-intensive glucose tolerance test. While gestational diabetes has previously been screened for with a simple urine dipstick, the new method will label a lot more women as being at risk for diabetes, including many who perhaps don’t even have gestational diabetes. The study was published on May 5, 2017, in The BMJ.

“In cases where early detection results in treating conditions that otherwise would regress or stagnate, the person would die with the condition and not of it. Treatment can in this case become a greater burden than the original disease would be,” concluded study authors Professor Bjørn Hofmann. MSc, PhD, and Professor John-Arne Skolbekken, PhD. “The presupposed benefits of early detection can lead to aggressive interventions, the benefits of which are uncertain at best.”

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Norwegian University of Science and Technology