Overdiagnosis -- and How We Need to Stop Harming the Healthy

By Perry, Susan | MinnPost.com, June 5, 2012 | Go to article overview

Overdiagnosis -- and How We Need to Stop Harming the Healthy


Perry, Susan, MinnPost.com


The problem of medical overdiagnosis is getting increasing attention -- and not a moment too soon, as noted in a commentary paper published last week in the journal BMJ.

"A burgeoning scientific literature is fueling public concerns that too many people are being overdosed, overtreated, and overdiagnosed," writes Australian journalist and academic researcher Ray Moynihan, Australian epidemiologist Jenny Doust, and Dr. David Henry, CEO of the Institute for Clinical Evaluative Sciences in Toronto, Canada.

"Screening programmes are detecting early cancers that will never cause symptoms or death, sensitive diagnostic technologies identify 'abnormalities' so tiny they will remain benign, while widening disease definitions mean people at ever lower risks receive permanent medical labels and lifelong treatments that will fail to benefit many of them. With estimates that more than $200 [billion] may be wasted on unnecessary treatment every year in the United States, the cumulative burden from overdiagnosis poses a significant threat to human health."

As the three authors point out, several factors are driving overdiagnosis ("including the best of intentions"), but technological changes lead the pack.

"The ability to detect smaller abnormalities axiomatically tends to increase the prevalence of any given disease," they write. "In turn this leads to overestimation of the benefits of therapies, as milder forms of the disease are treated and improvements in health are wrongly ascribed to treatment success, creating [as described in a 1998 study by Dartmouth University radiologist Dr. William Black] a 'false feedback' loop fuelling a 'cycle of increasing testing and treatment, which may eventually cause more harm than benefit.' "

But the ever-broadening definition of disease (often made by health professionals with a financial interest in widening a particular patient pool) is also at fault. The diagnostic criteria for many medical conditions are now so broad that "virtually the entire older adult population [can] be classified as having at least one chronic condition," write the BMJ authors.

"Increasingly we've come to regard simply being 'at risk' of future disease as being a disease in its own right," they add.

Examples of overdiagnosis

Moynihan, Doust and Henry offer examples of conditions that are commonly overdiagnosed, including seven for which the evidence of overdiagnosis is particularly "robust":

Breast cancer: "Systematic review suggests up to a third of screening detected cancers may be overdiagnosed. …

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