A common situation in clinical practice, where only a small proportion of cases of important diseases, the tip of the iceberg, are seen at an early stage in the natural history when intervention can achieve prevention, cure, or relief of symptoms. The metaphor of the tip and the submerged part of an iceberg is apt even in tropical countries; few people are unfamiliar with the concept. The proportion of missed cases varies. For some malignant neoplasms, such as cancer of the cervix, prostate, and breast, the size of the submerged portion has decreased with improved screening methods; for adult-onset diabetes, the submerged portion is about 50%; for psychiatric disorders, it may be as much as 75% to 80%; and for hypertension, it may be as high as 90%.
Subjects: public health and epidemiology.