Overdiagnosis across medical disciplines: a scoping review

Abstract

ObjectiveTo provide insight into how and in what clinical fields overdiagnosis is studied and give directions for further applied and methodological research.DesignScoping review.Data sourcesMedline up to August 2017.Study selectionAll English studies on humans, in which overdiagnosis was discussed as a dominant theme.Data extractionStudies were assessed on clinical field, study aim (ie, methodological or non-methodological), article type (eg, primary study, review), the type and role of diagnostic test(s) studied and the context in which these studies discussed overdiagnosis.ResultsFrom 4896 studies, 1851 were included for analysis. Half of all studies on overdiagnosis were performed in the field of oncology (50%). Other prevalent clinical fields included mental disorders, infectious diseases and cardiovascular diseases accounting for 9%, 8% and 6% of studies, respectively. Overdiagnosis was addressed from a methodological perspective in 20% of studies. Primary studies were the most common article type (58%). The type of diagnostic tests most commonly studied were imaging tests (32%), although these were predominantly seen in oncology and cardiovascular disease (84%). Diagnostic tests were studied in a screening setting in 43% of all studies, but as high as 75% of all oncological studies. The context in which studies addressed overdiagnosis related most frequently to its estimation, accounting for 53%. Methodology on overdiagnosis estimation and definition provided a source for extensive discussion. Other contexts of discussion included definition of disease, overdiagnosis communication, trends in increasing disease prevalence, drivers and consequences of overdiagnosis, incidental findings and genomics.ConclusionsOverdiagnosis is discussed across virtually all clinical fields and in different contexts. The variability in characteristics between studies and lack of consensus on overdiagnosis definition indicate the need for a uniform typology to improve coherence and comparability of studies on overdiagnosis.

Overdiagnosis in primary care: framing the problem and finding solutions

“…The scope of overdiagnosis in diseases other than cancer has not been well defined 61. Although screening for chronic non-cancer conditions such as hypertension, diabetes, and depression comprises much of the routine work of primary care, there are few estimates of the magnitude of overdiagnosis of these disorders.…”

Why clinicians overtest: development of a thematic framework

“…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 the causes and consequences of overtesting amongst the public, patients and clinicians remains limited. [3,8,9] Medical tests are an important rst step in the clinical management pathway, whether they are routine blood pressure measurements, blood tests, imaging studies or more specialised investigations.…”

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

“…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.…”

“…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.…”