# Overdiagnosis

Source: https://onco.cc/terms/overdiagnosis/  
OnCo record `overdiagnosis` (Term). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Finding a cancer that would never have caused symptoms or death in a person's lifetime, so that the diagnosis and treatment bring harm without benefit. It is the main downside of screening.

## Summary

Overdiagnosis is invisible to the individual: a screen-detected cancer is treated and the person is cured of a disease that would not have hurt them. It is measured at population level as the excess incidence in a screened group that is never matched by a deficit later. Estimates are around 10-20% of screen-detected breast cancers in most reviews (the UK Independent Breast Screening Review put it at about 19%), a large share of PSA-detected low-grade prostate cancers before MRI-first pathways, and much of the rise in thyroid cancer and thin melanoma incidence. Remedies include raising thresholds (MRI-first prostate screening, Lung-RADS), renaming indolent lesions, and active surveillance rather than treatment. Multi-cancer blood tests raise the same question for cancers with no screening today.

## Fields

- Kind: Term
- Last checked: 2026-09-10

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Overdiagnosis
- Independent UK Panel on Breast Cancer Screening (Lancet 2012): https://doi.org/10.1016/S0140-6736(12)61611-0

## Connected records

- terms: [Gallbladder polyp (polypoid lesion)](https://onco.cc/terms/gallbladder-polyp/), [Lead time, and lead-time bias](https://onco.cc/terms/lead-time-bias/), [Number needed to screen (and number needed to diagnose)](https://onco.cc/terms/number-needed-to-screen/), [Overtreatment](https://onco.cc/terms/overtreatment/), [Polygenic risk score (PRS)](https://onco.cc/terms/polygenic-risk-score/), [Prophylactic (preventive) cholecystectomy](https://onco.cc/terms/prophylactic-cholecystectomy/), [PSA (prostate-specific antigen)](https://onco.cc/terms/psa/), [Screening](https://onco.cc/terms/screening/), [Sensitivity and specificity](https://onco.cc/terms/sensitivity-specificity/), [Stage shift](https://onco.cc/terms/stage-shift/), [Template mapping biopsy (transperineal template prostate mapping)](https://onco.cc/terms/template-mapping-biopsy/)
- technologies: [Active surveillance](https://onco.cc/technologies/active-surveillance/), [Mammography & tomosynthesis](https://onco.cc/technologies/mammography/), [PSA and MRI-first prostate cancer screening](https://onco.cc/technologies/prostate-screening-psa-mri/), [Serum tumour markers: proper use and misuse](https://onco.cc/technologies/serum-tumour-markers/), [Skin cancer screening (visual skin examination)](https://onco.cc/technologies/skin-cancer-screening/)
- key papers: [ERSPC: screening and prostate cancer mortality in a randomised European study](https://onco.cc/key-papers/paper-schroder-erspc-screening-mortality-nejm-2009/), [Lead time and overdiagnosis in prostate-specific antigen screening: importance of methods and context](https://onco.cc/key-papers/paper-draisma-lead-time-overdiagnosis-psa-jnci-2009/), [Management and follow-up of gallbladder polyps: updated joint guidelines between the ESGAR, EAES, EFISDS and ESGE](https://onco.cc/key-papers/paper-gallbladder-polyp-joint-guideline-eur-radiol-2022/), [Outcomes of Gallbladder Polyps and Their Association With Gallbladder Cancer in a 20-Year Cohort](https://onco.cc/key-papers/paper-szpakowski-gallbladder-polyps-20-year-cohort-jama-netw-open-2020/), [Overdiagnosis and overtreatment of prostate cancer](https://onco.cc/key-papers/paper-loeb-overdiagnosis-overtreatment-prostate-eur-urol-2014/), [PIVOT: follow-up of prostatectomy versus observation for early prostate cancer](https://onco.cc/key-papers/paper-wilt-pivot-prostatectomy-observation-nejm-2017/), [Polyp size of 1 cm is insufficient to discriminate neoplastic and non-neoplastic gallbladder polyps](https://onco.cc/key-papers/paper-wennmacker-gallbladder-polyp-size-threshold-surg-endosc-2019/), [Prostate cancer diagnosis and treatment after the introduction of prostate-specific antigen screening, 1986 to 2005](https://onco.cc/key-papers/paper-welch-albertsen-psa-era-diagnosis-treatment-jnci-2009/), [Screening by chest radiograph and lung cancer mortality: the Prostate, Lung, Colorectal, and Ovarian (PLCO) randomized trial](https://onco.cc/key-papers/paper-plco-chest-radiograph-lung-cancer-mortality-jama-2011/), [Screening for Lung Cancer: US Preventive Services Task Force Recommendation Statement](https://onco.cc/key-papers/paper-uspstf-lung-cancer-screening-jama-2021/), [SPCG-4: radical prostatectomy or watchful waiting in prostate cancer, 29-year follow-up](https://onco.cc/key-papers/paper-bill-axelson-spcg-4-29-year-nejm-2018/), [The benefits and harms of breast cancer screening: an independent review](https://onco.cc/key-papers/paper-independent-uk-panel-on-breast-cancer-lancet/), [USPSTF 2012: screening for prostate cancer, recommendation statement (grade D)](https://onco.cc/key-papers/paper-moyer-uspstf-prostate-screening-ann-intern-med-2012/), [USPSTF 2018: screening for prostate cancer, recommendation statement (grade C at 55 to 69, grade D at 70 and over)](https://onco.cc/key-papers/paper-uspstf-prostate-screening-jama-2018/)
- cancers: [Lung cancer (all types)](https://onco.cc/cancers/lung-cancer/), [Prostate cancer](https://onco.cc/cancers/prostate/)
- ideas: [Judge a prostate screening programme on metastatic presentation, not on incidence or mortality](https://onco.cc/ideas/idea-prostate-metastatic-presentation-as-the-screening-endpoint/), [Risk-targeted ultrasound screening in high-incidence regions, tested against usual care](https://onco.cc/ideas/idea-gbc-risk-targeted-ultrasound-in-high-incidence-regions/)
- trials: [ERSPC (European Randomized Study of Screening for Prostate Cancer)](https://onco.cc/trials/erspc/), [GÖTEBORG-2 (MRI-based prostate cancer screening)](https://onco.cc/trials/goteborg-2/), [PLCO, prostate component (Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial)](https://onco.cc/trials/plco-prostate/), [TMIST (Tomosynthesis Mammographic Imaging Screening Trial)](https://onco.cc/trials/tmist/)
- journals: [JAMA Internal Medicine](https://onco.cc/journals/jama-internal-medicine/)

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