Earlier this month, the Dartmouth Institute for Health Policy and Clinical Practice hosted the Preventing Overdiagnosis conference. Co-sponsored by the BMJ, Bond University in Australia and Consumer Reports, this conference brought together over 300 attendees from more than 20 different countries. Among the attendees and presenters were some familiar faces. Michael Pignone, one of our medical editors, presented on value clarification in decision aids; Otis Brawley, author of the book How We Do Harm, spoke about cancer overdiagnosis and overtreatment; Annabel Bentley of Bupa presented findings about dealing with variations in rates of orthopedic surgeries and hysterectomies, a reflection of the work of the Dartmouth Atlas; and Charlie Brackett from Dartmouth presented interesting findings on decision quality and patient choice in PSA screening.
In addition to all the other amazing speakers at the conference, one presenter that deserves a special mention is Jolyn Hersch, from the University of Sydney. She presented her research on women’s views of overdiagnosis in breast cancer screening supported in part by a grant awarded from the Informed Medical Decisions Foundation. Specifically, she and her team looked at how women responded to information about breast cancer overdiagnosis through mammography, and whether or not the information influenced a woman’s decision to continue with screening. It was great to see how the results from this study have lead to the development of mammography decision support tools in Australia.
This conference shone a bright light on the prevalence of overdiagnosis and overtreatment in health care around the world. The challenge for the group will be to define the “right” rates of diagnosis and treatment, avoiding both under- and over-treatment. Involving informed patients in their health care decisions (and in future conferences) may be the best way to get to this happy medium. Meanwhile, many kudos to the meeting organizers for a terrific meeting on an under-recognized problem contributing to both cost and harm for people and populations.