Recognizing the potential for overdiagnosis: Are high-sensitivity cardiac troponin assays an example?

Overdiagnosis occurs when persons are labeled with a technically correct diagnosis that does not improve health outcomes (1). It is a common unintended consequence of early disease detection in asymptomatic persons but also takes place in persons with mild or ambiguous symptoms. Despite initiatives to prevent overdiagnosis (2), new tests and changes to disease definitions may become established in clinical practice before their potential for overdiagnosis is recognized; as such, reverting to previous approaches may be difficult. In this commentary, we propose questions (Figure) to identify new practices with the potential for overdiagnosis and evaluate the example of using high-sensitivity cardiac troponin (hs-cTn) assays to diagnose type 1 myocardial infarction.