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1-9 Earlier is not necessarily better

People often assume that early detection of disease leads to better outcomes. However, screening people to detect disease is only helpful if two conditions are met. First, there must be an effective treatment. Second, people who are treated before the disease becomes apparent must do better than people who are treated after the disease becomes apparent. Screening tests can be inaccurate (e.g. misclassifying people who do not have disease as having disease). Screening can also cause harm by labelling people as being sick when they are not and because of side effects of the tests and treatments.

Do not assume that early detection of disease is worthwhile if it has not been assessed in systematic reviews of fair comparisons between people who were screened and people who were not screened.

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Know Your Chances

This book has been shown in two randomized trials to improve peoples' understanding of risk in the context of health care choices.

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Screen test

Ben Goldacre notes that even if people realize that screening programmes have downsides, people don’t regret being screened.

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Cancer Screening Debate

This blog discusses problems that can be associated with cancer screening, including over-diagnosis and thus (unnecessary) over-treatment.

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Alicia

Earlier testing is not always better, and can lead to overdiagnosis and overtreatment.

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Gertrud

Exaggeration and hopes or fears can lead to unrealistic expectations about treatment effects.

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Who has diabetes?

So how do we decide who has diabetes? When I was in medical school, our numerical rule was this: if […]

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From person to patient

Screening will inevitably turn some people who test ‘positive’ into patients – a transformation not to be undertaken lightly. ‘If […]

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The Screening Circus

In 2009, a recently retired professor of neurology with a long-standing interest in stroke prevention learnt that neighbours had received […]

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Selling screening

‘Selling screening can be easy. Induce fear by exaggerating risk. Offer hope by exaggerating the benefit of screening. And don’t […]

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Is anyone normal?

Whole-body CT scans Among the tests on offer at private clinics are whole-body computed tomography (CT) scans to look at […]

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GET-IT provides plain language definitions of health research terms