Defining, Estimating, and Communicating Overdiagnosis in Cancer Screening

Abstract

The toll of inadequate health care is well-substantiated, but recognition is mounting that "too much" is also possible. Overdiagnosis represents one harm of too much medicine, but the concept can be confusing: It is often conflated with related harms (such as overtreatment, misclassification, false-positive results, and overdetection) and is difficult to measure because it cannot be directly observed. Because the U.S. Preventive Services Task Force (USPSTF) issues screening recommendations aimed largely at healthy persons, it has a particular interest in understanding harms related to screening, especially but not limited to overdiagnosis. In support of the USPSTF, the authors summarize the knowledge and provide guidance on defining, estimating, and communicating overdiagnosis in cancer screening. To improve consistency, thinking, and reporting about overdiagnosis, they suggest a specific definition. The authors articulate how variation in estimates of overdiagnosis can arise, identify approaches to estimating overdiagnosis, and describe best practices for communicating the potential for harm due to overdiagnosis.

A Review of the Presentation of Overdiagnosis in Cancer Screening Patient Decision Aids

“…Adopting standardized strategies for communication (e.g., plain language, magnitude of risk) and the inclusion of approaches to elicit values and priorities may 8 MDM Policy & Practice 00(0) enable a more functional conversation with regard to discussing overdiagnosis and why one may consider this harm when making a cancer screening decision. 50 An additional consideration is the potential to address skepticism regarding the discussion of the harms, like overdiagnosis, in the context of cancer screening. 48 The perception that services are being withheld by key stakeholders, like insurers, can trigger a strong reaction that can result in push back and distrust in discussions surrounding harms.…”

“…In addition, there may be concerns for the populations used in developing cancer screening guidelines and whether certain populations are represented in the data with which the guidelines were based. 50 This may contribute to how to communicate the magnitude of risk associated with overdiagnosis. 50 These considerations may be more critical for those who are older, from racial/ethnic minorities, and those with low socioeconomic status.…”

“…50 This may contribute to how to communicate the magnitude of risk associated with overdiagnosis. 50 These considerations may be more critical for those who are older, from racial/ethnic minorities, and those with low socioeconomic status. 48 The trade-offs regarding cancer screening and how to communicate them persist and warrant the development of effective communication strategies to support decision making.…”

“…48 The trade-offs regarding cancer screening and how to communicate them persist and warrant the development of effective communication strategies to support decision making. 18,50 Moreover, there is a strong ethical need to include the potential harms of cancer screening, including overdiagnosis, that can be understood by a broad population. 51 There are some limitations to consider.…”

Evidence of potential overdiagnosis and overtreatment of attention deficit hyperactivity disorder (ADHD) in children and adolescents: protocol for a scoping review

“…The two core concepts to be examined by this scoping review are ‘overdiagnosis of ADHD’ and ‘overtreatment of ADHD’. Debate over the definition of overdiagnosis is ongoing,1 16 17 37 38 especially in non-cancer contexts. We define overdiagnosis as occurring where a person is correctly diagnosed (according to contemporary professional standards) with a condition but the net effect of the diagnosis for the individual concerned is unfavourable (ie, when consideration is given to the balance of potential harms and benefits) 1 39.…”