Overdiagnosis

Deciding who is sick is a fundamental part of medical practice. But it's tricky. That's because many phenomena exist on a spectrum and it is often unclear where to draw the line between normal and abnormal.

 

What should be the cutoff between normal and high blood pressure? Normal and high cholesterol? Feeling sad and being depressed? Another challenge is the fact that many tests uncover silent abnormalities – like bulging disks in people without back pain, or sinusitis in people who feel well. Perhaps the most difficult problem is the overdiagnosis of cancer through screening tests:  that is the identification of cancers never destined to progress and which would never have caused harm if left undiscovered. 

Our Center is deeply interested in helping people understand and communicate the tradeoffs between too little diagnosis (missing problems that might benefit from earlier treatment) and overdiagnosis (harming people with problems that never needed to be found). 

Conference on Preventing Overdiagnosis

The conference will be held Sept. 15-17, 2014, hosted by the Centre for Evidence Based Medicine, Oxford University UK.

 

Media

Schwartz LM, Woloshin S.  Endless screenings don't ring everlasting health. New York Times April 16, 2012; Science Times. D5.
 

Too little? Too much? Primary care physicians' view on US Health Care
Arch of Internal Medicine, 2011;171: 1582-1585 Giving legs to restless legs: A case study of how the media helps make people sick
PLoS Med , 2006;Vol. 3 No. 4: e170: 452-455 Enthusiasm for cancer screening in the United States
JAMA, 2004;291: 71-78
Changing disease definitions:  Implications on disease prevalence.
Eff Clin Pract , 1999;Vol. 2: 76-85 Time Trends in Pulmonary Embolism in the United States: Evidence of Overdiagnosis
Arch Intern Med , 2011;Vol. 171: 831-837 Implications of expanding disease definitions: The case of osteoporosis
Health Affairs , 2007;26: 1702-11
US women's attitudes to false positive mammography results and detection of ductal carcinoma in situ: cross sectional survey
BMJ, 2000;320: 1635-40
knowledge informs change