Australia is responding to the complex challenge of overdiagnosis

Moynihan, Ray; Barratt, Alexandra; Buchbinder, Rachelle; Carter, Stacy M; Dakin, Thomas; Donovan, Jan; Elshaug, Adam G; Glasziou, Paul; Maher, C. G.; McCaffery, Kirsten; Scott, Ian

doi:10.5694/mja17.01138

Cited by 20 publications

(21 citation statements)

References 13 publications

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“…Concerns about the overdiagnosis and overtreatment of cancer have led to calls to investigate the problem . To facilitate the evaluation of interventions for reducing overdiagnosis, we estimated overdiagnosis levels in Australia for five of the seven cancers for which overdiagnosis has been documented: melanoma, and breast, prostate, thyroid and renal cancers.…”

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confidence: 99%

Estimating the magnitude of cancer overdiagnosis in Australia

Glasziou

Jones

Pathirana

et al. 2019

Medical Journal of Australia

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113

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Objectives To estimate the proportion of cancer diagnoses in Australia that might reasonably be attributed to overdiagnosis by comparing current and past lifetime risks of cancer. Design, setting, and participants Routinely collected Australian Institute of Health and Welfare national data were analysed to estimate recent (2012) and historical (1982) lifetime risks (adjusted for competing risk of death and changes in risk factors) of diagnoses with five cancers: prostate, breast, renal, thyroid cancers, and melanoma. Main outcome measure Difference in lifetime risks of cancer diagnosis between 1982 and 2012, interpreted as probable overdiagnosis. Results For women, absolute lifetime risk increased by 3.4 percentage points for breast cancer (invasive cancers, 1.7 percentage points), 0.6 percentage point for renal cancer, 1.0 percentage point for thyroid cancer, and 5.1 percentage points for melanoma (invasive melanoma, 0.7 percentage point). An estimated 22% of breast cancers (invasive cancers, 13%), 58% of renal cancers, 73% of thyroid cancers, and 54% of melanomas (invasive melanoma, 15%) were overdiagnosed, or 18% of all cancer diagnoses (8% of invasive cancer diagnoses). For men, absolute lifetime risk increased by 8.2 percentage points for prostate cancer, 0.8 percentage point for renal cancer, 0.4 percentage point for thyroid cancer, and 8.0 percentage points for melanoma (invasive melanoma, 1.5 percentage points). An estimated 42% of prostate cancers, 42% of renal cancers, 73% of thyroid cancers, and 58% of melanomas (invasive melanomas, 22%) were overdiagnosed, or 24% of all cancer diagnoses (16% of invasive cancer diagnoses). Alternative assumptions slightly modified the estimates for overdiagnosis of breast cancer and melanoma. Conclusions About 11 000 cancers in women and 18 000 in men may be overdiagnosed each year. Rates of overdiagnosis need to be reduced and health services should monitor emerging areas of overdiagnosis.

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confidence: 99%

Estimating the magnitude of cancer overdiagnosis in Australia

Glasziou

Jones

Pathirana

et al. 2019

Medical Journal of Australia

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113

101

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“…The first is that there is a clear need to inform consumers, clinicians, decision makers and the public about the extent of, and consequences of, overdiagnosis‐driven medical overuse in musculoskeletal health care. In parallel we need a research program to characterize the problem, identify causes and develop responses to address it …”

Section: Discussionmentioning

confidence: 99%

“…Overdiagnosis is an unwarranted diagnosis that leads to unnecessary treatments that do not benefit patients and that wastes health resources that could be better used elsewhere. Overdiagnosis also may cause harms: direct effects, unintended/indirect consequences, psychological impact, costs and resource implications, opportunity cost.…”

Section: Potential Drivers Of Overuse Of Musculoskeletal Health Servicesmentioning

confidence: 99%

Musculoskeletal healthcare: Have we over‐egged the pudding?

et al. 2019

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The phrase "to over-egg the pudding" is a terrific analogy for what is now increasingly common in health care: medical overuse. Cooks would know that if you skimp with the eggs a pudding won't hold together and if you use too many eggs the pudding will go rubbery.And in musculoskeletal health care we also need to get the balance right. People's health can suffer when they receive too little health care and also if they receive too much health care.This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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“…Overtesting has become a growing concern in contemporary healthcare, [1][2][3] with worldwide movements such as the Choosing Wisely, Less Is More, and Too Much Medicine campaigns bringing the issue to the fore. [1,[4][5][6][7] Despite this, awareness and understanding of overtesting amongst the public, patients and clinicians remains limited. [3,8,9] Screening and diagnostic tests are integral to clinical management, whether they are routine blood pressure measurement, blood tests, imaging studies or more specialised investigations.…”

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confidence: 99%

“…A less widely known harm from overtesting is overdiagnosis where people are labelled as having a "disease" for a condition that would not have caused them harm if it were left undetected and untreated. [1,5,6,[8][9][10][11][12] As well as harms from the disease label itself, overdiagnosis is usually associated with overtreatment, and may initiate a further cascade of unnecessary investigations and treatment. [1,10,11,[13][14][15] As such, using increasingly sensitive screening and diagnostic tests to detect more and earlier stage disease may sometimes cause more harm than good.…”

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confidence: 99%

Why do clinicians overtest? A narrative review and workshop group discussion exploring influences on clinician overtesting as possible causes of overdiagnosis

Lam

Pickles

Stanaway

et al. 2020

Preprint

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Background: Screening and diagnostic tests provide important information to guide clinical management. Overtesting however may cause harm to patients and the healthcare system, including through overdiagnosis. Clinicians are ultimately responsible for test requests, and therefore are ideally positioned to prevent overtesting and overdiagnosis. Through this narrative literature review followed by group discussion at a conference workshop (Preventing Overdiagnosis Conference [PODC], Sydney, 2019), we aimed to identify and categorise factors that influence clinicians to request potentially unnecessary screening and diagnostic tests that could result in overdiagnosis.Methods: Articles exploring factors affecting clinician test ordering behaviour were identified through a systematic search of MedLine in April 2019, forward and backward citation searches and content experts. Two authors screened abstract titles and abstracts, and two authors screened full text for inclusion. Identified factors were categorised into a preliminary framework which was subsequently presented at the PODC for iterative development.Results: The MedLine search yielded 542 articles; 55 were included. Another 10 articles identified by forward-backward citation and content experts were included, resulting in 65 articles in total. Following small group discussion with workshop participants, a revised thematic framework of factors was developed: ● “Interpersonal” – pressure from colleagues and medical culture; pressure from patients and doctor-patient relationship● “Contextual” – clinician knowledge and understanding; cognitive biases and experiences; contemporary medical practice and new technology● “Environmental or workplace” – guidelines, protocols and policies; financial incentives; time constraints, physical vulnerabilities and language barriers; pre-emptive testing to facilitate subsequent care; availability, ownership and ease of access to tests● “Intrapersonal” – fear of malpractice and litigation; intolerance of uncertainty and risk aversion; sense of medical obligation Conclusion: Through this thematic framework, clinicians can become more aware of their test ordering behaviour and feel empowered to limit overtesting and overdiagnosis. This framework may also guide the development of a scale assessing clinician knowledge, attitudes and practices around overtesting and overdiagnosis, to facilitate measurement of the effects of clinician-targeted interventions to prevent overdiagnosis.

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Australia is responding to the complex challenge of overdiagnosis

Cited by 20 publications

References 13 publications

Estimating the magnitude of cancer overdiagnosis in Australia

Estimating the magnitude of cancer overdiagnosis in Australia

Musculoskeletal healthcare: Have we over‐egged the pudding?

Why do clinicians overtest? A narrative review and workshop group discussion exploring influences on clinician overtesting as possible causes of overdiagnosis

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