Screening and Overdiagnosis - Better the Devil You Know?
New technologies and therapies in medicine have hugely improved the early diagnosis and treatment of many conditions. But, it’s becoming clear that these advances come with a cost. A significant number of people are now being told they have a condition, even though it is unlikely to cause symptoms or illness in their lifetime.
In reality, they will actually die from another primary cause and would perhaps never have known of the presence of an unlinked medical condition, had screening not been performed.
This is a problem because in some cases detection by screening can lead to over-medicalisation of benign conditions. It can mean that healthy people are reclassified as unhealthy and must disclose this “label”, and have to pay more for insurance and medicines as a result. The psychological effects of having this label may also have an impact on the individual.
Early diagnosis is likely to lead to better cure rates, but statistics can be misleading. With cancers, for example, identifying a lesion earlier in life leads to a numerically longer survival because the time following diagnosis is added to the period of survival.
The effect of screening is keenly felt in cancer diagnosis but can also occur in cardiovascular disease, chronic kidney disease, asthma, gestational diabetes and many others. All these conditions have a significant number of people with the label of the condition - but who may have been overdiagnosed.
Signs that overdiagnosis may be present include a rapidly rising incidence rate of the condition while the mortality rate stays the same. Cancers where this is evident include cancer of the breast, prostate, thyroid, kidney and skin (melanoma).
Clearly, there are big implications for insurers. For example, the underlying (or autopsy) prevalence of thyroid cancer is over 35% across all ages - all of these individuals would qualify for a payment under the standard UK Critical Illness cancer definition.
Increasingly, it is not just the label of a condition that should be assessed; the severity of the underlying condition has to be weighed by the underwriter. Cancers are already underwritten using guidelines that include such data. But, with other conditions such as abdominal aortic aneurysm, blood pressure and asthma, for example, the severity and medical interventions put in place to treat and reduce risk must also be taken into account.
For more on screening and overdiagnosis, read my full article published in Underwriting Focus.