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What is overdiagnosis ?

I have searched this Wiki result but didn't understood at all.

Can you please explain the first two line of Wikipedia :

Overdiagnosis is the diagnosis of "disease" that will never cause symptoms or death during a patient's lifetime. Overdiagnosis is a side effect of screening for early forms of disease.

Also

  • What is over treatment ?

  • Are overdiagnosis and over treatment same or different ?

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  • $\begingroup$ @dustin, You can't ping a person if the person is not involved anywhere in the question/comments. You must ping Anne somewhere where she has either answered or commented $\endgroup$ – One Face Feb 9 '15 at 1:53
  • $\begingroup$ There is a good video of a conference dealing with this issue. Take a look if you are interested. $\endgroup$ – One Face Feb 9 '15 at 2:16
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Overdiagnosis and overtreatment are intertwined. There is debate about how to best describe the problem, but narrowly defined, overdiagnosis occurs when increasingly sensitive tests - or changing definitions - identify abnormalities that are minor, non-progressive, or likely to resolve on their own, and that, if left untreated, will not cause symptoms or shorten an individual's life. Having a diagnosis makes well-persons think they're ill (overdiagnosis). If they are then treated for this diagnosis, they are overtreated.

An example involving changing definitions pertains to diabetes. When the official definition of diabetes changed from having a fasting blood sugar (FBS) of "X" or greater to an FBS of "X-y" or greater, 1.6 million new diabetics were instantly diagnosed, some of whom are not likely to develop symptoms and complications and are not likely to benefit from treatment. This is overdiagnosis.

If one goes on to put such a patient (let's say, on the lower end, "X-y+1" on a blood sugar (BS) lowering agent, and they pass out because their BS drops too low, then they are overtreated. If they happened to be driving when they pass out, and get into a fatal accident, they literally die from overtreatment, if it can't be shown that they would have suffered from a marginally elevated FBS. (If it can be shown to be dangerous to have an FBS of X-y+1, then this is a risk of treatment, not overtreatment.)

For an example of increased sensitivity of tests, say a new test is available, a blood test called a "D-dimer", which will reveal with 100% accuracy the presence of a dangerous pulmonary embolism (it's very sensitive). However, it is also known to be positive when there is no pulmonary embolism as well, but it's not known how often (so it's not specific). But it's an exciting new test!

A patient goes into the Emergency room for one of the following: atypical chest pain, dizziness, shortness of breath, leg pain consistent with a blood clot in the calf, or loss of consciousness. In addition to an EKG, chest x-ray (CXR) and a few other tests, a D-dimer is ordered. The EKG, CXR and other tests are negative, but the D-Dimer is positive. The tentative diagnosis is pulmonary embolism (PE).

Because the D-dimer indicates that a dangerous condition may be present, a spiral CAT Scan with contrast is ordered on all those people. Some will have a life-threatening PE (appropriately diagnosed*). A large number will have a negative CAT Scan. (diagnosis excluded) But a significant number will have a very small PE. Because this is relatively new and surprising, and it's not known whether they should be treated (maybe nothing will happen if they don't treat? Maybe this happens in normal people and we just never knew it?), the doctors, who are accustomed to treating all PE's will put the patients on blood thinners. This is overdiagnosis of PE, and treating it is overtreatment, because some treated people will have "bleeds" - a stroke, GI bleeding, other. It is now known that these tiny PE's are often seen in patients who suffer no harm at all from them, therefore in order to stem overdiagnosis (and subsequent overtreatment), the D-dimer test is ordered less frequently.

...[We] are in the midst of an epidemic of diagnosis. Conventional wisdom tells us that finding problems early saves lives because we have the opportunity to fix the problems early. [Conventional wisdom tells us that} There is no risk in finding things early. The truth is that early diagnosis is a double-edged sword; while it has the potential to help some, it has a potential to harm us. 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.

Overdiagnosed: Making People Sick in the Pursuit of Health
Overdiagnosis
Using Evidence to Combat Overdiagnosis and Overtreatment: Evaluating Treatments, Tests, and Disease Definitions in the Time of Too Much

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  • $\begingroup$ Are all overtreatments due to overdiagnosis? If yes, please mention it explicitly. If no, please make a distinction. $\endgroup$ – One Face Feb 9 '15 at 1:51
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    $\begingroup$ As with most things, it depends on your definition. If you define overtreatment as the result of overdiagnosis, as most do, then yes. If someone treats a medical condition which needs to be treated, but with more medicine than needed to control it, that is considered overaggressive treatment. If you define overaggressive at overtreatment (which confuses the issue which is very much discussed and written about), then you're correct. But in light of the issue, I would avoid that definition. $\endgroup$ – anongoodnurse Feb 9 '15 at 2:03
  • $\begingroup$ Thanks for clarifying. But overaggressive treatment is generally not considered overtreatment? Or is the definition not properly set yet (meaning no standard definition?) $\endgroup$ – One Face Feb 9 '15 at 2:08
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Screening is the process of testing the population enmasse to check for the presence of risk factors for a disease or to detect the early form of a disease.

  1. Usually the tests that are used in screening are not highly effective in excluding people who do not have the disease (low negative predictive value). Instead the goal of screening is to identify as many people as possible (high positive predictive value) who may have "the disease" which is being screened.

  2. When screening for early form of disease, people who may never develop the disease in their lifetimes are also detected and they may be treated without the actual need. In such cases the treatment will result in more harm than the disease itself.

Usually after screening, people who are recognised to have the risk factors are subjected to further confirmatory tests which will then exclude the people who do not have the disease.

Overdiagnosis is said to be done when a lot of people who don't have the disease at the present time are treated for the disease just because they have the risk factors for getting the disease or have the early form.

Overtreatment is not the same as overdiagnosis. Overtreatment refers to treating a disease more vigorously than warranted. The main difference is that in overtreatment, the treatment is provided for even correctly diagnosed disease but excessively. This may include unneeded medical procedures, injections etc...

For example getting antibiotics for a common cold (with just running nose) which has lasted for less than one week may be considered overtreatment.

Overdiagnosis may lead to overtreatment. However all overtreatment is not due to overdiagnosis.

Edit: I have edited the answer thanks to anongoodnurse.

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  • $\begingroup$ An X-ray is not a treatment. It can't be included with overtreatment, nor is a chest ray alone without findings ever part of overdiagnosis. That would be a negative CXR. Treating a newly diagnosed disease in it's early form may be very beneficial, e.g. with Multiple Sclerosis. That is not overdiagnosis or overtreatment. You've got a few things confused here. I don't know if this is because you over-rely on Wikipedia or not, but I think it may have something to do with it. $\endgroup$ – anongoodnurse Feb 9 '15 at 0:30
  • $\begingroup$ I have written nothing about chest xray and overdiagnosis. Are not redundant medical procedures considered overtreatment? Now that you said that unnecessary diagnostic procedures can't be considered overtreatment - what would they be called? (I am genuinely interested in knowing and not asking for the sake of arguement (which seem to set the tone between us in most of our conversations! Lol)) @anongoodnurse $\endgroup$ – One Face Feb 9 '15 at 1:42
  • $\begingroup$ "For example getting a X-ray for a common cold which has lasted for less than one week may be considered overtreatment." I assumed you meant a CXR? What other XRay is commonly obtained for a URI? $\endgroup$ – anongoodnurse Feb 9 '15 at 1:43
  • $\begingroup$ Yes, I meant chest x-ray but I did not mean that it was overdiagnosis. I did not mean to say that getting a chest x-ray was overdiagnosis. Just that it is unwarranted in such a case therefore unnecessary medical procedure - which (I thought) was overtreatment @anongoodnurse - This idea was corrected thanks to you. But I am interested in knowing what you call such unnecessary medical procedures $\endgroup$ – One Face Feb 9 '15 at 1:49

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