title: How to prevent overdiagnosis.
abstract: Overdiagnosis is the diagnosis of an abnormality that is not associated with a substantial health hazard and that patients have no benefit to be aware of. It is neither a misdiagnosis (diagnostic error), nor a false positive result (positive test in the absence of a real abnormality). It mainly results from screening, use of increasingly sensitive diagnostic tests, incidental findings on routine examinations, and widening diagnostic criteria to define a condition requiring an intervention. The blurring boundaries between risk and disease, physicians' fear of missing a diagnosis and patients' need for reassurance are further causes of overdiagnosis. Overdiagnosis often implies procedures to confirm or exclude the presence of the condition and is by definition associated with useless treatments and interventions, generating harm and costs without any benefit. Overdiagnosis also diverts healthcare professionals from caring about other health issues. Preventing overdiagnosis requires increasing awareness of healthcare professionals and patients about its occurrence, the avoidance of unnecessary and untargeted diagnostic tests, and the avoidance of screening without demonstrated benefits. Furthermore, accounting systematically for the harms and benefits of screening and diagnostic tests and determining risk factor thresholds based on the expected absolute risk reduction would also help prevent overdiagnosis.
authors.affiliation: Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Switzerland.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Chiolero
authors.affiliation: Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Switzerland.
authors.forename: Fred
authors.initials: F
authors.lastname: Paccaud
authors.affiliation: Department of General Internal Medicine, Bern University Hospital, Switzerland.
authors.forename: Drahomir
authors.initials: D
authors.lastname: Aujesky
authors.affiliation: La Source School of Nursing Sciences, University of Applied Sciences Western Switzerland, Lausanne, Switzerland.
authors.forename: Valérie
authors.initials: V
authors.lastname: Santschi
authors.affiliation: Department of General Internal Medicine, Bern University Hospital, Switzerland.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Rodondi
mesh_terms: D058070:Asymptomatic Diseases; D003675:Defensive Medicine; D003954:Diagnostic Services; D055088:Early Detection of Cancer / Q000009:adverse effects; D042241:Early Diagnosis; D004992:Ethics, Medical; D017408:Guidelines as Topic; D006801:Humans; D033162:Incidental Findings; D009369:Neoplasms / Q000175:diagnosis; D010817:Physician-Patient Relations; D019564:Unnecessary Procedures