Dr. Suzanne O'Sullivan
speaker
271 appearances
2 recordings
2 series
first heard Mar 2025
last heard Apr 2025
Dr. Suzanne O'Sullivan’s voice in public audio — every appearance, attributed to the second.
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Appearances
Very often, time is a better answer to medical problems than bunches of scans and loads of blood tests. You can be over-diagnosed very, very easily if a doctor sends you for a scan every time you go and see them.
Yeah, so I think that there's some fairly sort of there's some received wisdom, which is that earlier diagnosis are always for the better. If you catch a diagnosis early, you'll promote long term health. You know that the more health conditions you recognise, the more treatment you give, the more you promote long term health of the population.
And those assumptions, you know, they make a huge amount of sense. One can understand why we think that way. However, when we look at the statistics of diagnosis, we see something that suggests those assumptions may actually be quite problematic. So for several decades now, we've really been focused on diagnosing lots of things at earlier stages.
So, for example, we have screening programmes for cancer. that detect very early cancers. We have screening programs for learning problems that are detecting milder forms of problems like autism and ADHD. Now, if the assumption that early diagnosis and recognizing mild conditions was to our benefit was correct, We should be seeing the downstream effects of all that improved diagnosis.
We should be seeing fewer late stage cancers, fewer deaths from cancer. We should see children with better mental health going into adulthood, better able to progress through life. But we are actually seeing the opposite of all of those things. We are diagnosing lots of conditions earlier. So we've got lots of people becoming patients earlier than they would have before.
And we have just as many people with late stage problems.
If you look at people who have been diagnosed with early cancers on screening, you will see fewer deaths from cancers in those groups. But if you look at the overall mortality from cancer, we have a gradually increasing amount of cancer diagnosis with late stage cancer also.
And the reason that happens is because if you diagnose lots of people with early cancer cells, what people don't realise is that not every abnormal cell that looks cancerous will actually grow and cause long term health problems. Only certain cancer cells grow to become malignant, life threatening cancers. If you catch lots and lots of early cancer cells and treat them all as if they are
potentially going to be life threatening in the future, you'll be treating a lot of those people unnecessarily. But if you look at the survival rates for cancer in those people, they'll look fantastic because a lot of those people didn't need to be treated in the long run. They'll be very healthy. They'll attribute that to the cancer treatment, not knowing that the treatment was never necessary.
Yeah, so what I always say to people is, you know, you have to remember that a lot of the technology we have now to look inside the healthy body has only been available to us for a couple of decades. You know, the MRI scan came into regular use in the 1990s. The really good MRI scanners have only been around for a couple of decades now.
So we did not know for a very, very long time what the inside of the healthy body looked like. We were not able to genetically test mass numbers of people until the last 10 years. So what we have is...
sort of we've got all these new types of technology that allow us look inside the healthy body in a way that we never have before and we're detecting things that were always there that we didn't know were there so for example if you look at autism studies of people you will often find that they have small abnormal cells that didn't progress there was a study in detroit of men and they found that 45 of men in their 50s had prostate cancer at the time of death
their deaths were for things other than prostate cancer and that those numbers were substantially higher as men got older. So huge numbers of men have early cancer cells that never caused them in their prostate, that never caused them health problems. We didn't know about them because we didn't have the means to look for them.
So now that we're finding them, we're kind of acting on the assumption that all of them will progress because we simply don't have the knowledge base yet to know what factors make cancer cells grow in some people, but they don't grow in other people. How do you tell a serious cell that will progress from one that doesn't? So these cells have always been there.
And the difference now is we have the technology and the ability to see them.
Precisely. And, you know, a lot of countries don't do prostate screening because of the problems of overdiagnosis of prostate cancer. So some estimates would be that if you screen a thousand men for prostate cancer, you won't save any lives, but you will over-treat 10 to 20 men for prostate cancer who didn't need treatment because these abnormal cells in the prostate are so common.
The difficulty is that if a man presents for screening of his prostate and abnormal cells are found, how is he to react to that? Because it's very frightening to learn that you have abnormal cells. And there are watchful waiting programmes that suggest we don't have to overreact when this sort of thing is found.
But that can be very hard to do on an individual level if you don't know ahead of time that these things exist.
So a lot of focus at the moment with regard to something like heart disease is on identifying the risk factors that might put you at higher risk of heart disease going down the line. So, for example, something like diabetes or something like hypertension. So over the years, you know, there's no point at which a blood sugar suddenly turns into diabetes. There's no right point.
At some point, too much glucose on your blood means you're diabetic, but no one can say what that exact point is. And similarly, you know, what is normal blood pressure? You know, is it 140 over 80? Is it 130 over 80? Nobody knows. So what has been happening over the years in order to reduce the risk of something like heart disease or strokes down the line?
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