Overdiagnosis is defined as the diagnosis of an illness which would not produce symptoms during a person’s life; it’s the result of the correct diagnosis of an illness whose treatment and follow-up do not produce any benefit, but on the other hand, could be harmful and generate costs. Overdiagnosis is neither the consequence of an erroneous diagnosis, nor of a false positive test.
The broadest definition of overdiagnosis refers to its consequences: negative effects of unnecessary labelling, damage as consequence of medical tests (radiation effects, false positive or false negative test results), unnecessary therapy (surgery, medication) and the opportunity cost, generated by a misuse of resources which could have been assigned to prevention and treatment of real illnesses.
Well-known examples of overdiagnosis are the screening programs for the detection in an early stage of cancers, which would never cause neither symptoms in nor the death of a patient, or ever increasingly sensitive diagnostic methods, detecting the smallest of abnormalities which would remain benign anyway (incidentalomes). Also the progressive reduction of diagnostic thresholds can eventually lead to invented disorders and to the fact that healthy and asymptomatic persons could be classified as sick while they are not, receiving treatments with higher risks than possible benefits.
Let’s go back in time. The concept of overdiagnosis has been described for the first time approximately 50 years ago, in relation to cancer screening, but the term doesn’t become popular until the year 2011 through the book “Overdiagnosed. Making People Sick in the Pursuit of Health”. At present, overdiagnosis is discussed in some sections of prestigious scientific publications such as the BMJ (Too much medicine) or the JAMA (Less is more), and is the subject of some specific congresses as now the Preventing Overdiagnosis Conferences. In our specific context, there are also initiatives, such as Choosing Wisely and the Essencial, who work out recommendations to avoid clinical practices of little value and include subjects related to overdiagnosis.
Even with the knowledge presently available, overdiagnosis is still facing important challenges. A consensus on a formal definition is still missing, and under the umbrella of overdiagnosis, we still see a wide range of clinical situations gathered, requiring different approaches both from the scientific point of view, as well as from the perspective of necessary strategies to minimise the impact of overdiagnosis.
In order to meet these challenges, we need to deepen our knowledge of the methods used, in order to get an estimation of the frequency of overdiagnosis, as well as develop efficient communication strategies to avoid the confusion that situations of overdiagnosis can cause, both among patients as in society in general, the impact on the doctor-patient relationship (trust), or the potential jeopardy to patients who have already been diagnosed.
These challenges, together with the economic, social and ethical impact of overdiagnosis, its causes, facilitating elements and consequences, the new genomics tools and their possible impact on overdiagnosis, as well as matters related with overdiagnosis and aging, are some of the subjects which will be addressed during the 4th edition of the International Preventing Overdiagnosis Conference which will take place on the 20th, 21st and 22nd of September in Barcelona. You can read a previous post about it here.
The Agency for Health Quality and Assessment of Catalonia (AQuAS) is participating actively in the organisation of this international initiative, which gathers institutions like the Centre for Evidence Based Medicine from the Oxford University (UK), the Dartmouth Institute for Health Policy & Clinical Practice (USA), the Centre for Research in Evidence Practice of the Bond University (Australia), the Consumer Reports and the British Medical Journal (BMJ) and Public Library of Science (PLOS) groups.
Important information: Until the 31st March [deadline extended to April 15th], abstracts can be submitted without any thematic restriction, as long as they’re related to overdiagnosis prevention. You can register now.
We’ll be expecting you there!!!
Post written by Cari Almazán (@AlmazanCari).