Skip to main navigation menu Skip to main content Skip to site footer

Review article: Biomedical intelligence

Vol. 145 No. 0304 (2015)

How to prevent overdiagnosis

  • Arnaud Chiolero
  • Fred Paccaud
  • Drahomir Aujesky
  • Valérie Santschi
  • Nicolas Rodondi
DOI
https://doi.org/10.4414/smw.2015.14060
Cite this as:
Swiss Med Wkly. 2015;145:w14060
Published
11.01.2015

Summary

Overdiagnosis is the diagnosis of an abnormality that is not associated with a substantial health hazard and that patients have no benefit to be aware of. It is neither a misdiagnosis (diagnostic error), nor a false positive result (positive test in the absence of a real abnormality). It mainly results from screening, use of increasingly sensitive diagnostic tests, incidental findings on routine examinations, and widening diagnostic criteria to define a condition requiring an intervention. The blurring boundaries between risk and disease, physicians’ fear of missing a diagnosis and patients’ need for reassurance are further causes of overdiagnosis. Overdiagnosis often implies procedures to confirm or exclude the presence of the condition and is by definition associated with useless treatments and interventions, generating harm and costs without any benefit. Overdiagnosis also diverts healthcare professionals from caring about other health issues. Preventing overdiagnosis requires increasing awareness of healthcare professionals and patients about its occurrence, the avoidance of unnecessary and untargeted diagnostic tests, and the avoidance of screening without demonstrated benefits. Furthermore, accounting systematically for the harms and benefits of screening and diagnostic tests and determining risk factor thresholds based on the expected absolute risk reduction would also help prevent overdiagnosis.

References

  1. Greene JA. Prescription by numbers. Drugs and the definition of disease. Baltimore: The John Hopkins University Press, 2007.
  2. Welch HG, Black WC. Overdiagnosis in cancer. J Natl Cancer Inst. 2010;102(9):605–613.
  3. Welch HG. Overdiagnosed: Making People Sick in the Pursuit of Health. Boston, USA: Beacon Press; 2011.
  4. Moynihan R, Doust J, Henry D. Preventing overdiagnosis: how to stop harming the healthy. BMJ. 2012;344:e3502.
  5. Chiolero A, Paccaud F, Aujesky D, Santschi V, Rodondi N. Causes et prévention du surdiagnostic. Swiss Medical Forum. 2013;13(29–30):1–5.
  6. Esserman L, Thompson I. Solving the overdiagnosis dilemma. J Natl Cancer Inst. 2010;102(9):582–3.
  7. Black WC. Overdiagnosis: An underrecognized cause of confusion and harm in cancer screening. J Natl Cancer Inst. 2000;92(16):1280–2.
  8. Young RP, Hopkins RJ. Stage shift in computed tomography screening: possible role of indolent cancers, “histology shift”, and overdiagnosis. Am J Respir Crit Care Med. 2013;188(8):1034–5.
  9. Moyer VA; U.S. Preventive Services Task Force. Screening for prostate cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2012;157(2):120–34.
  10. Ilic D, Neuberger MM, Djulbegovic M, Dahm P. Screening for prostate cancer. Cochrane Database Syst Rev. 2013; 1:CD004720.
  11. Sandhu GS1, Andriole GL. Overdiagnosis of prostate cancer. J Natl Cancer Inst Monogr. 2012;45:146–51.
  12. Esserman L, Shieh Y, Thompson I. Rethinking screening for breast cancer and prostate cancer. JAMA. 2009;302(15):1685–92.
  13. Gulati R, Inoue LY, Gore JL, Katcher J, Etzioni R. Individualized Estimates of Overdiagnosis in Screen-Detected Prostate Cancer. J Natl Cancer Inst. 2014;106(2):djt367.
  14. US Preventive Services Task Force. Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2009;151(10):716–26.
  15. Independent UK Panel on Breast Cancer Screening. The benefits and harms of breast cancer screening: an independent review. Lancet. 2012;380(9855):1778–86.
  16. Pace LE, Keating NL. A systematic assessment of benefits and risks to guide breast cancer screening decisions. JAMA. 2014;311(13):1327–35.
  17. Bleyer A, Welch HG. Effect of three decades of screening mammography on breast-cancer incidence. N Engl J Med. 2012;367(21):1998–2005.
  18. Welch HG, Passow HJ. Quantifying the benefits and harms of screening mammography. JAMA Intern Med. 2014;174(3):448–54.
  19. Glusac EJ. The melanoma “epidemic”: lessons from prostate cancer. J Cutan Pathol. 2012;39(1):17–20.
  20. Veronesi G, Maisonneuve P, Bellomi M, Rampinelli C, Durli I, Bertolotti R, Spaggiari L. Estimating overdiagnosis in low-dose computed tomography screening for lung cancer: a cohort study. Ann Intern Med. 2012;157(11):776–84.
  21. Patz EF Jr, Pinsky P, Gatsonis C, Sicks JD, Kramer BS, Tammemägi MC, et al.; for the NLST Overdiagnosis Manuscript Writing Team. Overdiagnosis in Low-Dose Computed Tomography Screening for Lung Cancer. JAMA Intern Med. 2014;174(2):269–74.
  22. Hall SF, Irish J, Groome P, Griffiths R. Access, excess, and overdiagnosis: the case for thyroid cancer. Cancer Med. 2014. doi: 10.1002/cam4.184.
  23. Vollmer RT. Revisiting overdiagnosis and fatality in thyroid cancer. Am J Clin Pathol. 2014;141(1):128–32.
  24. Wiener RS, Schwartz LM, Woloshin S. Time trends in pulmonary embolism in the United States: evidence of overdiagnosis. Arch Intern Med. 2011;171(9):831–7.
  25. Hoffman JR, Cooper RJ. Overdiagnosis of disease: a modern epidemic. Arch Intern Med. 2012;172(15):1123–4.
  26. Goodman LR. Small pulmonary emboli: what do we know? Radiology. 2005;234(3):654–8.
  27. Ritchie G, McGurk S, McCreath C, Graham C, Murchison JT. Prospective evaluation of unsuspected pulmonary embolism on contrast enhanced multidetector CT (MDCT) scanning. Thorax. 2007;62(6):536–40.
  28. Rao VM, Levin DC. The overuse of diagnostic imaging and the Choosing Wisely initiative. Ann Intern Med. 2012;157(8):574–6.
  29. Young WF Jr. Clinical practice. The incidentally discovered adrenal mass. N Engl J Med. 2007;356(6):601–10.
  30. Furtado CD, Aguirre DA, Sirlin CB, Dang D, Stamato SK, Lee P, et al. Whole-body CT screening: spectrum of findings and recommendations in 1192 patients. Radiology. 2005;237(2):385–94.
  31. Solomon BD. Incidentalomas in genomics and radiology. N Engl J Med. 2014;370(11):988–90.
  32. Chiolero A, Paccaud F. Prediabetes, widening disease boundaries, and overdiagnosis. Lancet. 2012;380:1225.
  33. Doust J, Glasziou P. Is the problem that everything is a diagnosis? Aust Fam Physician. 2013;42(12):856–9.
  34. Law MR, Wald NJ. Risk factor thresholds: their existence under scrutiny. BMJ. 2002;324(7353):1570–6.
  35. Kaplan RM, Ong M. Rationale and public health implications of changing CHD risk factor definitions. Annu Rev Public Health. 2007;28:321–44.
  36. Chiolero A, Santschi V, Paccaud F. Public health surveillance with electronic medical records: at risk of surveillance bias and overdiagnosis. Eur J Pub Health. 2013;23(3):350–1.
  37. Aronowitz RA. The converged experience of risk and disease. Milbank Q. 2009;87(2):417–42.
  38. Cornell SJ. Another cause of overdiagnosis: fear of litigation. BMJ. 2013;347:f6969.
  39. Heath I. Overdiagnosis: when good intentions meet vested interests. BMJ. 2013;347:f6361.
  40. Biesheuvel C, Barratt A, Howard K, Houssami N, Irwig L. Effects of study methods and biases on estimates of invasive breast cancer overdetection with mammography screening: a systematic review. Lancet Oncol. 2007;8(12):1129–38.
  41. Zahl PH, Jørgensen KJ, Gøtzsche PC. Overestimated lead times in cancer screening has led to substantial underestimation of overdiagnosis. Br J Cancer. 2013;109(7):2014–9.
  42. Etzioni R, Gulati R, Mallinger L, Mandelblatt J. Influence of study features and methods on overdiagnosis estimates in breast and prostate cancer screening. Ann Intern Med. 2013;158(11):831–8.
  43. Esserman L, Shieh Y, Thompson I. Rethinking screening for breast cancer and prostate cancer. JAMA. 2009;302(15):1685–92.
  44. Schwartz LM1, Woloshin S, Fowler FJ Jr, Welch HG. Enthusiasm for cancer screening in the United States. JAMA. 2004;291(1):71–8.
  45. Esserman LJ, Thompson IM Jr, Reid B. Overdiagnosis and overtreatment in cancer: an opportunity for improvement. JAMA. 2013;310(8):797–8.
  46. Johansen ME; Gold KJ, Sen A, Arato N, Green LA. A National Survey of the Treatment of Hyperlipidemia in Primary Prevention. JAMA Intern Med. 2013;173(7):586–8.
  47. Moynihan RN, Cooke GP, Doust JA, Bero L, Hill S, Glasziou PP. Expanding disease definitions in guidelines and expert panel ties to industry: a cross-sectional study of common conditions in the United States. PLoS Med. 2013;10(8):e1001500.
  48. Carter HB. Active surveillance for prostate cancer: an underutilized opportunity for reducing harm. J Natl Cancer Inst Monograph. 2012;45:175–83.
  49. Zeelenberg M. Anticipated regret, expected feedback and behavioral decision making. J Behav Decis Making. 1999;12:93–106.
  50. Wegwarth O, Gigerenzer G. Overdiagnosis and overtreatment: evaluation of what physicians tell their patients about screening harms. JAMA Intern Med. 2013;173(22):2086–7.
  51. Stiggelbout AM, Van der Weijden T, De Wit MP, Frosch D, Légaré F, Montori VM, et al. Shared decision making: really putting patients at the centre of healthcare. BMJ. 2012;344:e256.
  52. Edwards AG, Naik G, Ahmed H, Elwyn GJ, Pickles T, Hood K, et al. Personalised risk communication for informed decision making about taking screening tests. Cochrane Database Syst Rev. 2013; 2:CD001865.
  53. Esserman L, Thompson I. Solving the overdiagnosis dilemma. J Natl Cancer Inst. 2010;102(9):582–3.
  54. Brito JP, Morris JC, Montori VM. Thyroid cancer: zealous imaging has increased detection and treatment of low risk tumours. BMJ. 2013;347:f4706.

Most read articles by the same author(s)

<< < 1 2 3 > >>