Overdiagnosis

Question 1

Making people patients unnecessarily

Answer 1

overdiagnosis

Question 2

How is over diagnosis done?

Answer 2

• Identifying problems that were never going to cause harm - I.e. Overdetection
• Medicalizing ordinary life experiences through expanded definitions of diseases - I.e. Overdefinition

Question 3

What is the result of overdiagnosis?

Answer 3

diagnosis causes more harms than benefits - E.g. triggers a cascade of over-treatment

Question 4

What is overdetection?

Answer 4

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
- Resolve spontaneously

Question 5

What is the issue with overdetection?

Answer 5

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 6

What are causes with over detection?

Answer 6

• Increased use of high-resolution imaging - E.g. Incidentalomas or Surgical overtreatment is a recognized risk of excessive CT imaging
• Self-testing
• Certain screening programs

Question 7

Surprise abnormalities unrelated to the original reason for doing the test

Answer 7

Incidentalomas

Question 8

How does overdefinition happen?

Answer 8

• Lowering threshold for a risk factor without evidence that this helps people live better or longer - E.g. 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

Question 9

What is a misleading consequence of overdefinition?

Answer 9

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

Question 10

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

Answer 10

Overselling (“disease mongering”)

Question 11

What are harms of overdiagnosis?

Answer 11

• Treatments offer little if any benefit for lower-risk patients, while harms (including costs) remain the same
• Psychological and behavioral effects of labelling - E.g. 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 12

T/F: Rise is diagnosis without a decrease in mortality is not overdiagnosis

Answer 12

False, it is

Question 13

What do you need to always ask with reference to lab tests?

Answer 13

• sensitivity
• specificity

Question 14

T/F: A plausible mechanism is not an appropriate justification

Answer 14

True

Question 15

If sensitivity & specificity are not available, do not?

Answer 15

assume the test provides information (i.e. an associated LR) that would justify its cost and do not assume you are avoiding overdetection and/or overdefinition