Diagnosing Overdiagnosis

“Overdiagnosis occurs when persons are labelled with a technically correct diagnosis that does not improve health outcomes”, write PCHSS investigators Professor Paul Glasziou, Professor Rachelle Buchbinder, and colleagues in a February 2019 commentary published in the Annals of Internal Medicine. Taking high-sensitivity cardiac troponin assays to diagnose type 1 myocardial infarction as a case example, the authors illustrate how overdiagnosis can manifest itself in a particular clinical context.

Photos of Professor Paul Glasziou and Professor Rachelle Buchinder
Professor Paul Glasziou and Professor Rachelle Buchinder

“Recognizing the Potential for Overdiagnosis: Are High-Sensitivity Cardiac Troponin Assays an Example?” outlines several questions that those responsible for establishing guidelines and policies ought to consider before recommending diagnostic procedures. The authors say that decision-makers should ask: whether such procedures will lead to increased diagnosis, whether any additional cases arising from new tests will be low risk, whether additional cases will receive treatment as a result of their diagnoses, and whether the potential harms of such treatments might outweigh the benefits.

The authors apply these questions to the subject of high-sensitivity cardiac troponin assays, highlighting a variety of potential downsides to the use of a test which, they state, became required or performed “before worldwide regulatory approval”. On this note, they state:

Our analysis underscores the need to better evaluate new tests before integration into usual care. The benefits from new tests may be smaller than expected, and there may be unanticipated harms from overuse and overdiagnosis.

Subscribe to our newsletter