Broadening risk factor or disease definition as a driver for overdiagnosis: A narrative review

Abstract

Medical overuse-defined as the provision of health services for which potential harms exceed potential benefits-constitutes a paradigm of low-value care and is seen as a threat to the quality of care. Value in healthcare implies a precise definition of disease. However, defining a disease may not be straightforward since clinical data do not show discrete boundaries, calling for some clinical judgment. And, if in time a redefinition of disease is needed, it is important to recognize that it can induce overdiagnosis, the identification of medical conditions that would, otherwise, never cause any significant symptoms or lead to clinical harm. A classic example is the impact of recommendations from professional societies in the late 1990s, lowering the threshold for abnormal total cholesterol from 240 mg/dl to 200 mg/dl. Due to these changes in risk factor definition, literally overnight there were 42 million new cases eligible for treatment in the United States. The same happened with hypertension-using either the 2019 NICE guidelines or the 2018 ESC/ECC guidelines criteria for arterial hypertension, the proportion of people overdiagnosed with hypertension was calculated to be between 14% and 33%. In this review, we will start by discussing resource overuse. We then present the basis for disease definition and its conceptual problems. Finally, we will discuss the impact of changing risk factor/disease definitions in the prevalence of disease and its consequences in overdiagnosis and overtreatment (a problem particularly relevant when definitions are widened to include earlier or milder disease).

Anaesthesia and environment: impact of a green anaesthesia on economics

“…Medical overuse is one of the major problems of modern medicine [26][27][28]. It simultaneously leads to too much care for healthy people, and not enough care for sick people [29].…”

Diagnosis and management of isthmocele (Cesarean scar defect): a SWOT analysis

“…Medical overuse has been defined as the provision of health services for which the potential harm exceeds the potential benefit. The negative consequences to patients that result from overtreatment can be psychological, physical, social or financial, and the treatment burden can cause distress and dissatisfaction with healthcare services 65,66 .…”

“…Thus, there is a need for consensus statements and definitions of normality. It is well documented that a change in a threshold value for a medical condition can lead to patient overtreatment 65 . Medical overuse has been defined as the provision of health services for which the potential harm exceeds the potential benefit.…”

Justification for the 2017 periodontitis classification in the light of the Checklist for Modifying Disease Definitions: A narrative review

“…In contrast, the introduction of a preclinical category of Alzheimer disease is as an example of a change in disease definition and classification that has had rather limited treatment implications. [3][4][5] In the field of periodontology, changes to the disease definition and classification are extremely frequent and numerous. Even so, there is little evidence to suggest that any of the many changes have had effect on the established treatment and control regimes.…”

“…The prevalence of diseases such as osteoporosis, prediabetes and thyroid cancer, has increased due to new definitions of diseases and of their risk factors. 3,4 In many cases, new definitions have been proposed even though the benefits associated with them are unknown. However, as the new definitions generally tend to include increasingly milder cases, these newly classified people have a lower probability of benefiting from the prognostic information and the medical interventions indicated by virtue of the new disease definitions and classifications.…”