Programme no. 105-WS
Public Health
Is it better to replace the old cancer screening technology with new and more sensitive technology or are the consequences more overdiagnosis and overtreatment?
John Brodersen*1, Bruno Heleno*2
1Research Unit and Section of General Practice, Department of Public Health,University of Copenhagen,Copenhagen,Denmark, 2Research Unit and Section of General Practice, Department of Public Health,University of Copenhagen,Copenhagen,Denmark
* = Presenting author
Objectives: Not applicable
Background: See content
Content: Medical diagnostic technology has throughout history been improved with increasing diagnostic accuracy as a consequence. Sometimes a new test would have a greater ability to capture those with the target condition (higher sensitivity), other times a new test would have a greater ability to identify those without the target condition (higher specificity) but rarely a new test would have both a greater sensitivity and a greater specificity compared to a previous diagnostic test.

In the traditional period (1750-1880), medicine focused on illness: people who felt sick sought help from doctors who relied exclusively on the history and physical exam to make diagnoses. The birth of modern pathology - with the invention of the microscope and bacteriology - allowed doctors to actually visualise abnormalities and pathology. This visualisation created a new paradigm for understanding disease: the abnormalities and pathology (disease) detected account for the symptoms (illness). The focus of medicine became detecting disease.

The shift from illness to disease has had a profound impact on modern medicine – particularly in the realm of cancer screening. In screening, it is not patients with illness who seek help from the healthcare system; it is asymptomatic healthy individuals who are invited into the healthcare system to be examined for pathology. The underlying assumption of screening is that abnormalities and pathology always progress to the point of serious troubling symptoms, disability, or death. If this were true it would always make sense to look for disease even when people feel well.

The present workshop will explore if the fundamental assumption that disease invariably leads to illness is valid and if not, what happens to screening test accuracy.

Method: Beside mini-lectures by GG and JB a lot of the time will be used to teach interactively and have one or two periods where people talk two-and-two and/or in small groups.
Other considerations: Not applicable