Louise Davies, MD, MS; Diana B. Petitti, MD, MPH; Lynn Martin, PhD †; Meghan Woo, ScD, ScM; Jennifer S. Lin, MD, MCR
Note: This project was done by the Kaiser Permanente Research Affiliates Evidence-based Practice Center under contract to the Agency for Healthcare Research and Quality (AHRQ) in support of the USPSTF. Staff from AHRQ provided oversight and assisted in the external review of the companion draft evidence synthesis.
Disclaimer: The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ or the Department of Veterans Affairs. Therefore, no statement in this report should be construed as an official position of these (or their parent) entities.
Acknowledgment: The authors thank Sarah Bean, MPH, for project management and administrative support and Katherine K. Essick, BS, for editorial support. They also thank Alex Krist, MD, MPH; Prajakta Adsul, MBBS, PhD; Quyen Ngo-Metzger, MD, MPH; and Tracy Wolff, MD, MPH, members of the USPSTF Methods Workgroup and the USPSTF chairs, for their valuable feedback on earlier drafts of this work.
Financial Support: This article is based on work done by the Kaiser Permanente Research Affiliates Evidence-based Practice Center under contract HHSA-290-2012-00015-I to AHRQ and by Abt Associates under contract HHSA290201600006C to AHRQ.
Disclosures: Dr. Davies reports funding from AHRQ to support the USPSTF and editorial help for this work from the Kaiser Permanente Center for Health Research. Dr. Petitti reports funding from AHRQ to support the USPSTF and editorial help for this work from the Kaiser Permanente Center for Health Research; she is a past member of the USPSTF. Dr. Martin reports funding from AHRQ to support the USPSTF and as part of the Scientific Resource Center. Dr. Woo reports funding from AHRQ to support the USPSTF and as part of the Scientific Resource Center. Dr. Lin reports funding from AHRQ to support the USPSTF and as part of the Evidence-based Practice Center program; she is director of the Kaiser Permanente Research Affiliates Evidence-based Practice Center. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M18-0694.
Corresponding Author: Louise Davies, MD, MS, VA Outcomes Group 111B, 215 North Main Street, White River Junction, VT 05009; e-mail, firstname.lastname@example.org.
Current Author Addresses: Dr. Davies: VA Outcomes Group 111B, 215 North Main Street, White River Junction, VT 05009.
Dr. Petitti: 711 West Lodge Drive, Phoenix, AZ 85041.
Dr. Woo: 10 Fawcett Street, Cambridge, MA 02318.
Dr. Lin: 3800 North Interstate Avenue, Portland, OR 97227.
Author Contributions: Conception and design: L. Davies, D.B. Petitti, M. Woo, J.S. Lin.
Analysis and interpretation of the data: L. Davies, D.B. Petitti, L. Martin.
Drafting of the article: L. Davies, D.B. Petitti, M. Woo, J.S. Lin.
Critical revision of the article for important intellectual content: D.B. Petitti, L. Martin, M. Woo, J.S. Lin.
Final approval of the article: L. Davies, D.B. Petitti, M. Woo, J.S. Lin.
Obtaining of funding: L. Martin, J.S. Lin.
Administrative, technical, or logistic support: L. Martin, J.S. Lin.
Collection and assembly of data: L. Davies, D.B. Petitti, L. Martin.
The toll of inadequate health care is well-substantiated, but recognition is mounting that “too much” is also possible. Overdiagnosis represents one harm of too much medicine, but the concept can be confusing: It is often conflated with related harms (such as overtreatment, misclassification, false-positive results, and overdetection) and is difficult to measure because it cannot be directly observed. Because the U.S. Preventive Services Task Force (USPSTF) issues screening recommendations aimed largely at healthy persons, it has a particular interest in understanding harms related to screening, especially but not limited to overdiagnosis. In support of the USPSTF, the authors summarize the knowledge and provide guidance on defining, estimating, and communicating overdiagnosis in cancer screening. To improve consistency, thinking, and reporting about overdiagnosis, they suggest a specific definition. The authors articulate how variation in estimates of overdiagnosis can arise, identify approaches to estimating overdiagnosis, and describe best practices for communicating the potential for harm due to overdiagnosis.
Davies L, Petitti DB, Martin L, Woo M, Lin JS. Defining, Estimating, and Communicating Overdiagnosis in Cancer Screening. Ann Intern Med. 2018;169:36–43. doi: 10.7326/M18-0694
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Published: Ann Intern Med. 2018;169(1):36-43.
Published at www.annals.org on 26 June 2018
Cancer Screening/Prevention, Hematology/Oncology, Prevention/Screening.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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