Australia is responding to the complex challenge of overdiagnosis

To the Editor: Moynihan and colleagues1 make a good case for Australia responding to the complex challenge of reducing the overdiagnosis of clinical disease. However, this challenge should not lead to confusion with the early diagnosis of and the early intervention in preclinical disease, which are the mainstay of secondary prevention. While reducing diagnosis creep and expanding disease definitions are predominantly the realm of the specialist disciplines, primary care is uniquely placed to embrace preclinical disease diagnosis, increasing early detection and intervention, while specialists endorse reducing overdiagnosis, both collaborating in lowering long term costs to the health system.

Preclinical disease and its impact are emerging as the logical next challenge. Prediabetes, for example, is almost always present before the onset of diabetes.2,3 Both the American Diabetes Association3 and Diabetes Australia4 have published recommendations on the diagnosis and screening for diabetes and prediabetes. The American Diabetes Association also leads the way in recommending that screening should be considered in children and adolescents who are overweight or obese and who have additional risk factors for diabetes.3

In 2015, the most comprehensive undertaking since Medicare's inception in the 1980s was established to consider how the more than 5700 items on the Medicare Benefits Schedule (MBS) could be aligned with contemporary clinical evidence and practice and improve health outcomes for patients with clinical disease (tertiary prevention).5

Although, the evidence base around early diagnosis and intervention is relatively recent, it is now opportune for the federal government to initiate a second tier to the MBS Review to consider new MBS items, where appropriate, for the early diagnosis of and early intervention in preclinical disease (secondary prevention). Further, this would align well with the new global awareness and endorsement of lifestyle medicine.6

Reversing the underdiagnosis of preclinical disease would be the perfect partner to reversing the overdiagnosis of clinical disease in delivering better health outcomes for patients, while reducing long term costs to the health system.