Overdiagnosis

Question 1

Making people patients unnecessarily

Answer 1

Overdiagnosis

Question 2

Identifying problems that were never going to cause harm

Answer 2

Overdetection

Question 3

Medicalizing ordinary life experiences through expanded
definitions of diseases

Answer 3

Overdefinition

Question 4

What is the result of overdiagnosis?

Answer 4

diagnosis causes more harm than benefits. Triggers a cascade of over-treatment

Question 5

Overdetection

Answer 5

Finding abnormalities that fit one or more of the following criteria:
1. were never going to cause harm
2. do not progress
3. 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
4. resolve spontaneously

Question 6

Issue with overdetection

Answer 6

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

Question 7

What are some causes of over-detection

Answer 7

1. increased use of high-resolution imaging
   - Incidentalomas: surprise abnormalities unrelated to the original reason for doing the test
   - surgical overtreatment is recognized risk of excessive CT imaging
2. self-testing
3. certain screening programs

Question 8

Overdefinition happens by:

Answer 8

1. lowering the threshold for a risk factor without evidence that this helps people live better or longer
   - lowering the systolic blood pressure that defines
   hypertension for all adults from 150 to 130 mmHg
2. expanding disease definitions to include people with ambiguous or mild symptoms

Question 9

Will Rogers phenomenon

Answer 9

lower a threshold so now healthier people are included in the disease
population, making it appear that the new definition helps people

MISLEADING CONSEQUENCE

Question 10

disease mongering

Answer 10

categorizing unpleasant
experiences most people have from time to time as diseases

• OVERSELLING

Question 11

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

Question 12

Psychological and behavioural effects of labelling

Answer 12

Higher rates of suicide in men within a year of prostate
cancer diagnosis

Question 13

HARMS = Adverse consequences of:

Answer 13

• Subsequent testing (including invasive tests)
• Follow-up

Question 14

HARM = misinformation spreads

Answer 14

those who may have been
overdiagnosed encourage others to undergo testing

Question 15

What does a rise in diagnosis without a decrease in mortality

Answer 15

OVERDETECTION

Question 16

Tests may give results that reflect something going on in the patient’s
body without having any significant relationship with the disease. How do we address this?

Answer 16

Always ask:
* What is the sensitivity?
* What is the specificity?

Question 17

If these answers are not available, do not assume the test provides
information (i.e. an associated LR) that would justify its cost and do

Do not assume you are avoiding overdetection and/or over definition

Question 18

A plausible mechanism is not an appropriate justification

Question 19

____________ makes people into patients unnecessarily;
leading to more harm than good

Answer 19

Overdiagnosis

Question 20

_________ tends to occur in scenarios that promote overdetection and/or over-definition

Answer 20

Overdiagnosis

Question 21

________________ tests can contribute to overdiagnosis

Answer 21

Unvalidated lab tests can contribute to overdiagnosis