W 13

Question 1

Define Overdiagnosis?

Answer 1

• making people patients unnecessarily
• diagnosis causes more harms than benefits (triggers a cascade of over-treatment)

Question 2

False +ive NOT the same as over diagnosis or over treatment, but can lead to it.
True or False

Answer 2

True

Question 3

What is overdetection?

Answer 3

finding abnormalities that were:
- never going to do harm
- never going to 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)
- resolve spontaneously

Question 4

What are the causes of over-detection?

Answer 4

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

Question 5

What is Over-definition?

Answer 5

• lowering threshold for a risk factor without evidence that this helps people live better or longer
• expanding disease definitions to include people with ambiguous or mild symptoms
• medicalizing ordinary life experiences through expanded definitions of diseases

Question 6

What is the “misleading consequence” of over-definition?

Answer 6

healthier people are included in disease population, making it appear that the new definition helps people (Will Rogers phenomenon)

Question 7

What is “overselling” in over definition?

Answer 7

“disease mongering”, categorizing unpleasant experiences most people have from time to time as diseases

Question 8

Harms of over-diagnosis?

Answer 8

1. treatment offer little if any benefit for lower-risk patients, while harms (including costs) remain the same
2. Psychological and behavioral aspects of labeling
3. adverse consequences of:
   - subsequent testing (includes invasive tests)
   - follow-up
4. misinformation spreads (those who may have been over-diagnosed encourage others to undergo testing

Question 9

a plausible mechanism is NOT an appropriate justification.
True or False

Answer 9

True

Question 10

What is unvalidated lab tests?

Answer 10

Tests may give results that reflect something going on in the patient’s body without having any significant relationship with disease