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Overdiagnosis across medical disciplines: a scoping review
  1. Kevin Jenniskens1,
  2. Joris A H de Groot1,
  3. Johannes B Reitsma1,2,
  4. Karel G M Moons1,2,
  5. Lotty Hooft1,2,
  6. Christiana A Naaktgeboren1
  1. 1 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
  2. 2 Dutch Cochrane Centre, University Medical Center Utrecht, Utrecht, The Netherlands
  1. Correspondence to Kevin Jenniskens; k.jenniskens{at}umcutrecht.nl

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.

  • overdiagnosis
  • overdetection
  • scoping review
  • too much medicine

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Footnotes

  • Contributors KJ, JAHdG and CAN have contributed to the conception and design of the study. KJ, JAHdG and CAN have contributed to the establishment of search and scoring criteria. Article reviewing, scoring and data analysis has been performed by KJ. KJ, JAHdG, JBR, KGMM, LH and CAN have made contributions to the drafting and revising of the article. KJ, JAHdG, JBR, KGMM, LH and CAN have approved the final version to be published and its accuracy and integrity.

  • Funding Netherlands Organization for Scientific Research (project 918.10.615).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Readers interested in using our database on overdiagnosis for specific purposes related to their respective research are invited to do so by contacting the first author through the corresponding email address.

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