Using Evidence to Combat Overdiagnosis and Overtreatment: Evaluating Treatments, Tests, and Disease Definitions in the Time of Too Much

摘要

While a large part of the world's population faces the problems of underdiagnosis and undertreatment, it is apparent that a “modern epidemic” of overdiagnosis afflicts high-income countries [1], with tangible human and financial costs of the unnecessary management of overdiagnosed diseases [2],[3]. While there is ongoing debate about how to best describe the problem, narrowly defined, overdiagnosis occurs when increasingly sensitive tests identify abnormalities that are indolent, non-progressive, or regressive and that, if left untreated, will not cause symptoms or shorten an individual's life. Such overdiagnosis leads to overtreatment when these “pseudo-diseases” are conventionally managed and treated as if they were real abnormalities; because these findings have a benign prognosis, treatment can only do harm. More broadly defined, overdiagnosis happens when a diagnostic label is applied to people with mild symptoms or at very low risk of future illness, for whom the label and subsequent treatment may do more harm than good [3].