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The dark side of early diagnosis

For years, patients have been told that an early diagnosis can save their life. What if this advice is wrong?
@REX SHUTTERSTOCK

What can add five years to your life without lengthening it by a single day, improve the performance of the NHS while wasting its resources, and make people grateful for unnecessary suffering? The answer is early diagnosis.

Early diagnosis sounds like a no-brainer. The NHS has targets for speedy diagnosis and treatment of cancer, and offers screening for a wide range of conditions, in babies, children and adults. Private medicine and charities offer even more.

Much of this early diagnosis can, without doubt, be a very good thing. What’s surprising is that in the wrong hands or the wrong circumstances, it can also be a very bad one. To make matters more complicated, sometimes it can be hard to tell the good early diagnosis from the bad. The story of our attempts to put the logic of early diagnosis into practice is a hard lesson in the human costs of failing to communicate that uncertainty, and the dangers that lurk in the intuitively obvious.

To see how easily we can be misled, start with a definitional trick that makes early diagnosis appear a good thing, simply by moving the goalposts. Imagine your cancer is diagnosed at a late stage, aged 66, and you die from it four years later aged 70. Your cancer might have been sitting unrecognised for years. If only you had known.

Then, in another life, your wish is granted. This is the parallel world which, in a recent speech about how AI would soon tackle cancer, Theresa May held up as her vision of the future. “Every year, 22,000 fewer people will die within five years of their diagnosis compared to today.” So thanks to screening, you get your diagnosis earlier at, say, 62.

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About Prospect Magazine

In Prospect's September issue: Twenty-five years after the Oslo Accords, Israeli politician and former Knesset speaker Avraham Burg and journalist Donald Macintyre explore how the idea of a two-state solution to the Israel/Palestine conflict has diminished, with Burg arguing that a one-state solution is the only way forward. Jane Martinson visited the offices of the UK’s biggest-selling newspaper—Metro—to find out how it has risen to the top. Adam Tooze charts the ups and downs of the euro and argues that decisions made by the ECB have hampered the currency during its first 20 years in existence. Elsewhere in the issue: Michael Blastland suggests that early diagnosis isn’t all it’s made out to be and that many people have endured unnecessary suffering in an attempt to live longer. Wendy Ide examines the life and work of director David Lynch as she reviews his new memoir, which offers a glimpse behind the curtain.