Overdiagnosis and overtreatment: Beware of guidelines with expanded disease definition

Along with other aspirations, shared decision making (SDM) has the laudable aim of bringing more scrutiny of evidence into our health care choices, including assessing the risks and benefits of all treatment options. But as evidence about the problem of ‘overdiagnosis’ grows, we may need to bring more attention to the risks and benefits of a diagnostic label, even before any scrutiny of the pros and cons of possible treatments. This chapter explores how heavily conflicted guideline panels are expanding disease definitions, labelling those with milder symptoms or at lower risks, for whom a diagnosis and treatment may do more harm than good. It explores several examples where there is controversy over recently widened definitions. The chapter concludes that if we’re to better inform people about the risks of overdiagnosis and related overtreatment, and ultimately assist in reducing them, genuine SDM will include information about controversies over disease definitions.