Quaternary prevention at Wonca world conference Prague 2013



Poster # 336

Quaternary prevention; from Wonca world Hong Kong 1995 to Wonca world Prague 2013

Wonca world congress Poster# 336. Prague 2013.  abstract 


Marc Jamoulle & Michel Roland. General practitioners, Belgium

During the World Wonca congress in Hong Kong 1995, the Quaternary Prevention concept (P4), supported by the Wonca International Classification Committee in its Durham meeting, has been presented as a poster by the same authors.


As stated in Wonca dictionary of family Medicine (Bentzen, 2003), quaternary prevention definition is “Action taken to identify a patient or a population at risk of overmedicalisation, to protect them from invasive medical interventions and provide for them care procedures which are scientifically and medically acceptable.” 

18 years later, the concept has turned around the world and is now taught in many medicine schools. After a successful Wonca Europe Basel workshop, Wonca world Prague welcomes a workshop that provides speakers from 6 countries and 4 continents.


The draws used in various publications are shown on the poster in an attempt to explain visually the concept and refer to the corresponding quotes.


Links with the actual controversy about overscreening, overdiagnosis and overtreatment are indicated. Several mailing list addresses and websites related to Quaternary prevention are also displayed.

More about P4 on www.ph3c.org

Oral communication

Breast cancer; screening or overdiagnosis? Questioning of a family doctor

Lassoued Ibrahim, Jamoulle Marc

Free university of Brussels.  IRSS-UCL

The authors have tried to update the knowledge of breast cancer screening by a review of the scientific literature, the recommendations made by various national health institutions as well as expert advices. It attempts to identify the limitations of screening and the potential adverse effects of the overdiagnosis and overtreatment.  
The current literature has been reviewed, as well as books on the issues of screening, the work of some experts aim to clarify the following points :

    • The potential benefit of routine screening of women aged 50 to 69 years
    • The risks and potential side effects of breast cancer screening by mammography.
  • Informing women invited to screening

State institutions (KCE, HAS, Canadian Task Forces, U.S. Task Forces) recommend maintaining the screening of women aged 50 to 69 years and consider the benefit is higher than adverse events (false positives, false negatives and treatment of tumors growing very slow).  Nevertheless, the findings of the Cochrane and Prescrire are reserved. For them, even if there is a benefit, it is minimal and insufficient as to have a definite opinion on the matter. Indeed, the NNS (Need Number to Screen) for 10 years is 2000. At the same time 10 healthy women will be treated unnecessarily for a cancer and 200 women will be falsely alerted by screening.Biased information given to patients rises false beliefs. All these beliefs conveyed can lead to a breakdown in the relationship between doctor and patient


Created 17/12/2012 - Last modified 27/11/2015