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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.

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