What intervention has the best likelihood of reducing overdiagnosis (excessive diagnosis)?

From the Guidelines

Implementing evidence-based screening guidelines with clear thresholds for diagnosis and treatment is the most effective intervention for reducing overdiagnosis. This approach involves using appropriate age-based and risk-stratified screening protocols rather than universal testing, and establishing reasonable diagnostic thresholds that balance disease detection with the risk of overtreatment 1.

Key Considerations

• Healthcare systems should focus on shared decision-making between providers and patients, ensuring individuals understand both the benefits and potential harms of screening tests before proceeding.
• Regular review and updating of diagnostic criteria based on current evidence is essential, as is providing clinicians with education about overdiagnosis and its consequences.
• The reported frequency of overdiagnosis varies widely in the published literature, with estimates ranging from 0% to 54%, whereas adjusted estimates range from 1% to 10% 1.

Reducing Overdiagnosis

• Overdiagnosis estimates increase with age at screening, highlighting the need for age-based screening protocols 1.
• By focusing screening efforts on populations most likely to benefit and establishing meaningful thresholds for intervention, healthcare systems can reduce unnecessary diagnoses while still identifying clinically significant disease requiring treatment.
• Screening mammography decreases breast cancer mortality, but it also has risks, including false-positive recalls and biopsies, overdiagnosis, and patient anxiety 1.

Evidence-Based Guidelines

• The American College of Radiology recommends implementing evidence-based screening guidelines with clear thresholds for diagnosis and treatment to reduce overdiagnosis 1.
• Annual screening mammography results in a greater reduction in mortality compared to biennial screening, but it also increases the number of false-positive examinations and biopsies 1.
• Women should continue screening mammography as long as they remain in overall good health and are willing to undergo the examination and subsequent testing or biopsy, if an abnormality is identified 1.

From the Research

Interventions to Reduce Overdiagnosis

To address the issue of overdiagnosis, several interventions can be considered. The most effective approach is likely to involve a combination of strategies. Some potential interventions include:

• Improving awareness among physicians and patients about the risks of overdiagnosis 2, 3
• Implementing evidence-based screening guidelines and diagnostic standards 2, 3
• Enhancing patient education and shared decision-making regarding screening and testing 4
• Encouraging the use of less invasive and more targeted diagnostic tests 5, 6
• Addressing financial incentives and medical culture that may contribute to overdiagnosis 2

Key Considerations

When developing interventions to reduce overdiagnosis, it is essential to consider the following factors:

• The need for clear and consistent terminology to facilitate understanding of the issue 2
• The importance of international coordination regarding diagnostic standards and disease definitions 2
• The potential for overdiagnosis to occur in various clinical contexts, not just cancer screening 2, 3
• The need for ongoing research and evaluation to better understand the scope and consequences of overdiagnosis 3, 5, 4, 6

Targeted Approaches

Some studies suggest that targeted approaches may be effective in reducing overdiagnosis, particularly in the context of cancer screening. For example:

• Focusing on the detection of aggressive, fast-growing cancers rather than slow-growing or dormant cancers 3
• Developing more effective screening tests that can distinguish between harmful and harmless cancers 5, 6
• Implementing risk-based screening strategies that take into account individual patient factors and preferences 4