Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, USA.
Department of Medicine and Center for Health Policy and Outcomes, Memorial Sloan Kettering Cancer Center, New York, NY 10017, USA.
BMJ. 2018 Aug 14;362:k2820. doi: 10.1136/bmj.k2820.
Overdiagnosis, is defined as the diagnosis of a condition that, if unrecognized, would not cause symptoms or harm a patient during his or her lifetime, and it is increasingly acknowledged as a consequence of screening for cancer and other conditions. Because preventive care is a crucial component of primary care, which is delivered to the broad population, overdiagnosis in primary care is an important problem from a public health perspective and has far reaching implications. The scope of overdiagnosis as a result of services delivered in primary care is unclear, though overdiagnosis of indolent breast, prostate, thyroid, and lung cancers is well described and overdiagnosis of chronic kidney disease, depression, and attention-deficit/hyperactivity disorder is also recognized. However, overdiagnosis is a known consequence of all screening and can be assumed to occur in many more clinical contexts. Overdiagnosis can harm patients by leading to overtreatment (with associated potential toxicities), diagnosis related anxiety or depression, and labeling, or through financial burden. Many entrenched factors facilitate overdiagnosis, including the growing use of advanced diagnostic technology, financial incentives, a medical culture that encourages greater use of tests and treatments, limitations in the evidence that obscure the understanding of diagnostic utility, use of non-beneficial screening tests, and the broadening of disease definitions. Efforts to reduce overdiagnosis are hindered by physicians' and patients' lack of awareness of the problem and by confusion about terminology, with overdiagnosis often conflated with related concepts. Clarity of terminology would facilitate physicians' understanding of the problem and the growth in evidence regarding its prevalence and downstream consequences in primary care. It is hoped that international coordination regarding diagnostic standards for disease definitions will also help minimize overdiagnosis in the future.
过度诊断是指诊断出一种在患者有生之年如果不被识别就不会引起症状或危害患者的疾病，而且它越来越被认为是癌症和其他疾病筛查的后果。由于预防保健是初级保健的一个重要组成部分，而初级保健是为广大人群提供的，因此，从公共卫生的角度来看，过度诊断是一个重要问题，具有深远的影响。尽管过度诊断惰性乳腺癌、前列腺癌、甲状腺癌和肺癌已得到很好的描述，慢性肾脏病、抑郁症和注意力缺陷/多动障碍的过度诊断也已得到认可，但由于初级保健服务导致的过度诊断范围尚不清楚。然而，过度诊断是所有筛查的已知后果，可以假设它会出现在更多的临床环境中。过度诊断会通过导致过度治疗（伴随潜在的毒性）、与诊断相关的焦虑或抑郁以及标记，或者通过经济负担来伤害患者。许多根深蒂固的因素助长了过度诊断，包括先进诊断技术的广泛使用、经济激励、鼓励更多使用测试和治疗的医疗文化、掩盖诊断效用理解的证据局限性、使用无益的筛查测试以及疾病定义的扩大。减少过度诊断的努力受到医生和患者对该问题缺乏认识以及术语混淆的阻碍，过度诊断常常与相关概念混淆。术语的明确性将有助于医生理解该问题，并有助于增加关于其在初级保健中的普遍性及其下游后果的证据。希望关于疾病定义诊断标准的国际协调也将有助于未来减少过度诊断。
