Analysis

The challenge of overdiagnosis begins with its definition

BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h869 (Published 04 March 2015) Cite this as: BMJ 2015;350:h869
  1. S M Carter, associate professor 1,
  2. W Rogers, professor 2,
  3. I Heath, retired general practitioner3,
  4. C Degeling, postdoctoral research fellow1,
  5. J Doust, professor4,
  6. A Barratt, professor5
  1. 1Centre for Values, Ethics and the Law in Medicine, University of Sydney, NSW 2006, Australia
  2. 2Philosophy Department and Australian School of Advanced Medicine, Macquarie University, NSW, Australia
  3. 3London, UK
  4. 4Faculty of Health Sciences and Medicine, Bond University, Australia
  5. 5Sydney School of Public Health, Sydney, Australia
  1. Correspondence to: S M Carter stacy.carter{at}sydney.edu.au
  • Accepted 28 January 2015

Overdiagnosis means different things to different people. S M Carter and colleagues argue that we should use a broad term such as too much medicine for advocacy and develop precise, case by case definitions of overdiagnosis for research and clinical purposes

The implicit social contract underpinning healthcare is that it will reduce illness and preventable death and improve quality of life. But sometimes these promises are not delivered. Sometimes health services take people who don’t need intervention, subject them to tests, label them as sick or at risk, provide unnecessary treatments, tell them to live differently, or insist on monitoring them regularly.1 These interventions don’t improve things for people; they produce complications or illness, reduce quality of life, or even cause premature death. Active health intervention is not always a good thing: it can be “too much medicine,” or produce what is often called overdiagnosis. Although the concept of overdiagnosis has been described in the literature for nearly 50 years in relation to cancer screening,2 3 it was Welch and colleagues’ 2011 book, Overdiagnosed: Making People Sick in the Pursuit of Health, that popularised the term.4

Overdiagnosis is now an acknowledged problem for patients, clinicians, researchers, and policymakers; it is discussed in journals5 6 7 and at specialist conferences8 and addressed through policy and practice initiatives.9 10 11 There is, however, no formal, agreed definition of overdiagnosis. Rather, the word has become a banner under which disparate people with similar general concerns can unite. This vagueness and breadth allows the appearance of unity but does not serve the more exacting demands of research and healthcare. Here we examine the meanings of overdiagnosis more closely and discuss related challenges for healthcare professionals, patients, and researchers. If overdiagnosis is to be understood and mitigated, the …

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