Overdiagnosis

Question 1

Overdiagnosis:

Answer 1

Making people patients unnecessarily:

done by:
-identifying problems that were never going to cause harm (overdetection)

-Medicalizing ordinary life experiences through expanded definitions of diseases (overdefinition)

Result: diagnosis causes more harms than benefits
ex) triggers a cascade of over treatment

Question 2

Overdetection:

Answer 2

Finding abnormalities that fit one or more of the following criteria:
-Were never going to cause harm
-Do not progress
-Progress too slowly to cause symptoms or harm during a person’s remaining lifetime
(includes situations where there is concurrent disease that will lead to earlier mortality)
-Resolves spontaneously

Issue: often in medicine it is not known if a condition in a particular individual will lead to clinical consequences-Need more research in this area

Question 3

Overdetection causes:

Answer 3

Increased use of high-resolution imaging (ex. Incidentalomas)
-surprise abnormalities unrelated to the original reason for doing the test

Surgical overtreatment is recognized risk of excessive CT imaging

Self-testing

Certain screening programs

Question 4

Overdefinition:

Answer 4

Happens by:
-lowering threshold for a risk factor without evidence that this helps people live better or longer
ex) lowering the systolic blood pressure that defines hypertension for all adults from 150 to 130 mmHg

-Expanding disease definitions to include people with ambiguous or mild symptoms

-Misleading consequence: healthier people are included in disease population, making it appear that the new definition helps people (“will rogers phenomenon”)

-Overselling (“disease mongering”): categorizing unpleasant experiences most people have from time to time as diseases

Question 5

Harms:

Answer 5

Treatments offer little if any benefit for lower-risk patients, while harms (including costs) remain the same

Psychological and behavioral effects of labelling
ex) higher rates of suicide in men within a year of prostate cancer diagnosis

Adverse consequences of:
-subsequent testing (including invasive tests)

-Follow up

Misinformation spreads: those who may have been overdiagnosed encourage others to undergo testing

Question 6

Summary:

Answer 6

1) Overdiagnosis makes people into patients unnecessarily leading to more harm than good

2) Overdiagnosis tends to occur in scenarios that promote overdetection and/or definition

3) Unvalidated lab tests can contribute to overdiagnosis