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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Committees of specialists have been gradually changing the parameters required to be diagnosed with something like prediabetes or hypertension, with the idea that if you address these issues, you'll prevent heart disease at a later date. Now, this runs into the same difficulties as the early cancer diagnosis.
If you adjust the parameters of blood pressure to identify more people as hypertensive, as happened not that very long ago, you can... identify huge numbers of people as being potentially hypertensive and potentially at risk of heart disease or stroke. But actually, of those huge number of people, you will certainly be helping a percentage of them.
Maybe 20% of them will genuinely be at risk of stroke. But you are inevitably going to be over treating maybe 80% of them who are never at risk because they didn't have other high risk factors. And similarly, if you identify lots of people with prediabetes, only a percentage of those people would actually develop diabetes if you didn't identify them.
So you've always got this health economics going on where you're saying, I identify 100 people. 10 of them might benefit, but 90 of them will probably not benefit from this intervention. And the assumption all the time is that the intervention doesn't do any harm, so that's okay. You've saved 10 people and the other 90 people have just gotten some good advice in health monitoring.
But of course, it's not as simple as that. Health monitoring in itself has problems.
Well, I mean, with regard to sort of if somebody notices a symptom and goes to the doctor, we do. You know, I'm certainly not advocating that they don't do that. The distinction I'm making is between us as a scientific and medical community seeking out patients who are asymptomatic. So I'm talking about asymptomatic cancers and asymptomatic hypertension patients. and asymptomatic prediabetes.
If we work really hard to try and find loads of asymptomatic people at risk of problems, we overdiagnose. But obviously, symptomatic disease is a completely different thing that does need to be taken more seriously. However...
When it comes to things that come to a doctor and how one should approach that, very often the time is a better answer to medical problems than bunches of scans and loads of blood tests. You know, medicine and diagnosis is still a clinical art. Tests need to be put into a clinical perspective.
you will get a better and more reliable diagnosis from a good doctor who takes time listening to you and examining you than you will from a scan. Because again, the problem is that scans and blood tests, they pick up irregularities all the time. You can be overdiagnosed very, very easily if a doctor sends you for a scan every time you go and see them.
I mean, obviously, finding progressive cancer early is the aim. But the difficulty is that... Our science isn't very good at doing it yet. So I'm not suggesting this won't be a wonderful strategy in the future. But unfortunately, there are some cancers and pancreatic cancer would be one of those that spreads very quickly and therefore screening programs don't work very well for those.
So, for example, ovarian cancer spreads very quickly. You don't have a screening program for that because by the time it's found, it's often already spread and that can be a difficulty. So other cancers spread very slowly or grow or don't grow at all. And that's where overdiagnosis, so underdiagnosis occurs in some cancers because they're hard to detect or they spread very quickly.
Overdiagnosis occurs in other cancers because some don't grow at all. So there's absolutely no doubt that the logic behind that we should try and find them early is the correct one. But the point is, we're not very good at doing that yet. We just have not mastered that yet.
Well, that's precisely the point of how one could perhaps think about how one deals differently with this issue of screened cancers. So, again, I'm talking a cancer that presents with symptoms is completely different. But let's say a cancer found on screening. You can actually consider a watchful waiting program for those cancers.
So a lot of abnormal breast cancer cells and a lot of abnormal prostate cancer cells don't necessarily progress to be life threatening. And what you can do in those situations is do exactly what you're suggesting, which is monitor them with scans over time to look to see, is this one that's progressing or is it staying the same?
At the moment, because the word cancer is such a frightening one, you know, we feel a bit compelled into action. People need to know that, you know, these cancers are not all equal. A screen cancer is not exactly the same as a symptomatic cancer. And you do have time to think. But to be able to have time to think, you need to understand that these cancers don't all grow.
And you also need to have a good doctor by your side supporting you while you have serial testing to see whether you are one of the lucky ones who has just cells that aren't going to grow or if you're one of the unlucky ones.
I guarantee you, Mike, I would be exactly the same. You know, if I, you know, I do have cancer screening because in the UK it's recommended on a regular basis. I have the standard screening. And if something is found, even with the knowledge that I have now, I would be just as frightened as anybody else. And I would also feel compelled to act.
And I think probably one of the issues there is we're calling all of these things cancers. But that's not necessarily representative of what is being found. So what some people would argue is that we should give these kind of abnormal cells found on screening a different name to cancer.
Because the minute we kind of hear, oh, it's a cancer, well, you just want it out and you'll be subjecting yourself to treatment which could be harmful in itself.
So to solve that problem of fear, because fear compels us into doing things that aren't necessarily the best thing for us, and perhaps to solve the problem of fear, we should give these screened abnormal cells a name that is less frightening than cancer.
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