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

Summary Points
- Overdiagnosis and related overtreatment are increasingly recognised as major problems.
- “Positive” average results from trials of treatments can mask situations where many participants at low risk of disease may receive no benefit.
- The evaluation of diagnostic tests usually involves assessing how well tests detect presence versus absence of a certain disease—rather than how well they detect clinically meaningful stages of disease.
- Changes to disease definitions typically do not involve evaluation of potential harms of overdiagnosis, and are often conducted by heavily conflicted panels.
- We offer suggestions for improving the way evidence is produced, analysed, and interpreted, to help combat overdiagnosis and related overtreatment. These include routine consideration of overdiagnosis and related overtreatment in studies of tests and treatments, and clearer stratification by baseline risk to identify treatment thresholds where benefits are likely to outweigh harms.