Public Largely Unaware of the Potential Negative Effects of Cancer Overdiagnosis Interview with:
Dr Alex Ghanouni
Research Associate
UCL Research Department of Epidemiology and Public Health
Health Behaviour Research Centre
London What is the background for this study? What are the main findings?

Dr. Ghanouni: This study comes out of growing concern among academics, doctors, and policymakers about the unintended harms of healthcare interventions. One prominent issue in the ongoing debate is ‘overdiagnosis’, that is detection of disease that would not have caused symptoms or death if it had remained undetected. There are many contexts in which overdiagnosis can occur but one of the most prominent is cancer screening, in which asymptomatic individuals undergoing testing may have slow-growing cancers detected that would never have otherwise come to light. However, because it is impossible to be sure which cancers are slow-growing and which are aggressive, most are treated. This means that overdiagnosis can lead to harm through the anxiety caused by a disease label and the negative effects of treatment (e.g. surgery) that is actually unnecessary.

Despite professional concern about overdiagnosis, previous research has found that the public is mostly unaware that it exists. One study that was particularly relevant to our research was an Australian survey in which members of the public were asked whether they had encountered the term before and what they thought it meant. Although around half the sample stated that they had heard or seen the term before, only 41% were able to provide a definition that was approximately correct. We tested the extent to which this was true as part of an online survey of adults aged 50-70 years in the UK. We found that recognition of the term was very low (only 30%) and almost no-one (3%) gave an answer that was strictly accurate. Responses often indicated misconceptions (e.g. “misdiagnosis”, “false positive diagnosis”, or being “overly health conscious”). What should clinicians and patients take away from your report?

Dr. Ghanouni: As has been found by studies based in other countries, awareness of “overdiagnosis” appears to be very low in the UK. Although the term is relatively well-recognised in healthcare circles, it has yet to reach public consciousness. Furthermore, the word does not have an intuitive meaning to the public. What recommendations do you have for future research as a result of this study?

Dr. Ghanouni: Future research could investigate whether other terms (e.g. ‘unnecessary detection’) are relatively easy for people to interpret. In addition, we found some surprising definitions of “overdiagnosis” that we categorised under the label of “overthinking” (e.g. “Complicating a problem by thinking too much about it”). The survey format precluded a detailed exploration of what participants meant in these cases and future research would be necessary to get a better understanding. Thank you for your contribution to the community.


Alex Ghanouni, Susanne F Meisel, Cristina Renzi, Jane Wardle, Jo Waller. Survey of public definitions of the term ‘overdiagnosis’ in the UK. BMJ Open, 2016; 6 (4): e010723 DOI:10.1136/bmjopen-2015-010723

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Dr Alex Ghanouni (2016). Public Largely Unaware of the Potential Negative Effects of Cancer Overdiagnosis