What intervention has the best likelihood of reducing overdiagnosis, which is the diagnosis of a condition that would not cause symptoms or harm during a patient's lifetime?

From the Guidelines

Implementing risk-stratified screening protocols is the most effective intervention for reducing overdiagnosis, as it targets only those patients most likely to benefit from diagnosis and treatment, while avoiding unnecessary testing in those unlikely to experience harm from their condition 1. This approach involves using evidence-based risk assessment tools to identify individuals at higher risk for clinically significant disease. For example, in breast cancer screening, considering factors like age, family history, and breast density to determine appropriate screening intervals can help reduce overdiagnosis 1.

Some key points to consider when implementing risk-stratified screening protocols include:

• Using age-specific screening intervals, such as biennial screening for women aged 50 to 74 years, as recommended by the USPSTF 1
• Considering family history and breast density when determining screening intervals 1
• Avoiding annual screening, which can lead to more false-positive results and overdiagnosed cases 1
• Combining risk-stratified approaches with shared decision-making conversations between clinicians and patients to clearly explain the potential benefits and harms of screening, including the possibility of overdiagnosis 1

By focusing medical resources on cases where early detection is most likely to provide meaningful health benefits, risk-stratified screening protocols can help reduce the psychological, physical, and financial harms that can result from diagnosing conditions that would never have caused symptoms or required treatment during a person's lifetime 1.

From the Research

Interventions to Reduce Overdiagnosis

To address the issue of overdiagnosis, which is defined as the diagnosis of a condition that would not cause symptoms or harm during a patient's lifetime, several interventions can be considered. The goal is to identify the intervention with the best likelihood of reducing overdiagnosis.

Potential Interventions

• Heightened sensitization of health professionals and patients: Increasing awareness among healthcare professionals and patients about the occurrence of overdiagnosis can help prevent it 2, 3.
• Active surveillance and deferred treatment: Waiting for early signs of disease progression before starting treatment can reduce overtreatment and overdiagnosis 3.
• Targeted screening: Screening should be targeted and based on demonstrated benefits to minimize overdiagnosis 2, 3.
• Balanced information on screening risks and benefits: Providing patients with clear information about the risks and benefits of screening can help them make informed decisions and reduce overdiagnosis 3.
• Adjusting screening frequency and thresholds for image-guided biopsy: Adjusting screening protocols, such as those used in breast cancer screening, can help mitigate potential overdiagnosis 4.
• Emerging technologies like breast radiomics: New technologies that can identify imaging-based biomarkers associated with tumor biology may help reduce overdiagnosis by preventing unnecessary treatment for indolent cancers 4.

Most Effective Intervention

Based on the available evidence, targeted screening appears to have a high likelihood of reducing overdiagnosis. By ensuring that screening is only performed when benefits are demonstrated and targeting it to those who are most likely to benefit, the risk of overdiagnosis can be minimized 2, 3. Additionally, heightened sensitization of health professionals and patients about the issue of overdiagnosis can lead to more cautious use of diagnostic tests and treatments, further reducing overdiagnosis 2, 3.