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Overdiagnosis across medical disciplines: a scoping review.
BMJ Open. 2017 Dec 27;7(12):e018448
Authors: Jenniskens K, de Groot JAH, Reitsma JB, Moons KGM, Hooft L, Naaktgeboren CA
Abstract
OBJECTIVE: To provide insight into how and in what clinical fields overdiagnosis is studied and give directions for further applied and methodological research.
DESIGN: Scoping review.
DATA SOURCES: Medline up to August 2017.
STUDY SELECTION: All English studies on humans, in which overdiagnosis was discussed as a dominant theme.
DATA EXTRACTION: Studies were assessed on clinical field, study aim (ie, methodological or non-methodological), article type (eg, primary study, review), the type and role of diagnostic test(s) studied and the context in which these studies discussed overdiagnosis.
RESULTS: From 4896 studies, 1851 were included for analysis. Half of all studies on overdiagnosis were performed in the field of oncology (50%). Other prevalent clinical fields included mental disorders, infectious diseases and cardiovascular diseases accounting for 9%, 8% and 6% of studies, respectively. Overdiagnosis was addressed from a methodological perspective in 20% of studies. Primary studies were the most common article type (58%). The type of diagnostic tests most commonly studied were imaging tests (32%), although these were predominantly seen in oncology and cardiovascular disease (84%). Diagnostic tests were studied in a screening setting in 43% of all studies, but as high as 75% of all oncological studies. The context in which studies addressed overdiagnosis related most frequently to its estimation, accounting for 53%. Methodology on overdiagnosis estimation and definition provided a source for extensive discussion. Other contexts of discussion included definition of disease, overdiagnosis communication, trends in increasing disease prevalence, drivers and consequences of overdiagnosis, incidental findings and genomics.
CONCLUSIONS: Overdiagnosis is discussed across virtually all clinical fields and in different contexts. The variability in characteristics between studies and lack of consensus on overdiagnosis definition indicate the need for a uniform typology to improve coherence and comparability of studies on overdiagnosis.
PMID: 29284720 [PubMed - in process]