{"entity":{"id":"overdiagnosis","kind":"term","name":"Overdiagnosis","aka":[],"tldr":"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.","asOf":"2026-09-10","wikipedia":"https://en.wikipedia.org/wiki/Overdiagnosis","links":[{"label":"Independent UK Panel on Breast Cancer Screening (Lancet 2012)","url":"https://doi.org/10.1016/S0140-6736(12)61611-0"}],"tags":[],"related":["lead-time-bias","overtreatment","number-needed-to-screen"],"cancers":[],"sections":[],"technologies":["prostate-screening-psa-mri","mammography","active-surveillance","skin-cancer-screening"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["screening","stage-shift","sensitivity-specificity","psa","lead-time-bias","overtreatment","number-needed-to-screen"],"trials":[],"people":[],"bottlenecks":[],"keyPapers":["paper-independent-uk-panel-on-breast-cancer-lancet"],"journals":[],"dependsOn":[],"notes":[],"category":"Epidemiology & prevention"},"route":"/terms/overdiagnosis/","neighbours":{"term":[{"id":"gallbladder-polyp","kind":"term","name":"Gallbladder polyp (polypoid lesion)","route":"/terms/gallbladder-polyp/"},{"id":"lead-time-bias","kind":"term","name":"Lead time, and lead-time bias","route":"/terms/lead-time-bias/"},{"id":"number-needed-to-screen","kind":"term","name":"Number needed to screen (and number needed to diagnose)","route":"/terms/number-needed-to-screen/"},{"id":"overtreatment","kind":"term","name":"Overtreatment","route":"/terms/overtreatment/"},{"id":"polygenic-risk-score","kind":"term","name":"Polygenic risk score (PRS)","route":"/terms/polygenic-risk-score/"},{"id":"prophylactic-cholecystectomy","kind":"term","name":"Prophylactic (preventive) cholecystectomy","route":"/terms/prophylactic-cholecystectomy/"},{"id":"psa","kind":"term","name":"PSA (prostate-specific antigen)","route":"/terms/psa/"},{"id":"screening","kind":"term","name":"Screening","route":"/terms/screening/"},{"id":"sensitivity-specificity","kind":"term","name":"Sensitivity and specificity","route":"/terms/sensitivity-specificity/"},{"id":"stage-shift","kind":"term","name":"Stage shift","route":"/terms/stage-shift/"},{"id":"template-mapping-biopsy","kind":"term","name":"Template mapping biopsy (transperineal template prostate mapping)","route":"/terms/template-mapping-biopsy/"}],"technology":[{"id":"active-surveillance","kind":"technology","name":"Active surveillance","route":"/technologies/active-surveillance/"},{"id":"mammography","kind":"technology","name":"Mammography & tomosynthesis","route":"/technologies/mammography/"},{"id":"prostate-screening-psa-mri","kind":"technology","name":"PSA and MRI-first prostate cancer screening","route":"/technologies/prostate-screening-psa-mri/"},{"id":"serum-tumour-markers","kind":"technology","name":"Serum tumour markers: proper use and misuse","route":"/technologies/serum-tumour-markers/"},{"id":"skin-cancer-screening","kind":"technology","name":"Skin cancer screening (visual skin examination)","route":"/technologies/skin-cancer-screening/"}],"paper":[{"id":"paper-schroder-erspc-screening-mortality-nejm-2009","kind":"paper","name":"ERSPC: screening and prostate cancer mortality in a randomised European study","route":"/key-papers/paper-schroder-erspc-screening-mortality-nejm-2009/"},{"id":"paper-draisma-lead-time-overdiagnosis-psa-jnci-2009","kind":"paper","name":"Lead time and overdiagnosis in prostate-specific antigen screening: importance of methods and context","route":"/key-papers/paper-draisma-lead-time-overdiagnosis-psa-jnci-2009/"},{"id":"paper-gallbladder-polyp-joint-guideline-eur-radiol-2022","kind":"paper","name":"Management and follow-up of gallbladder polyps: updated joint guidelines between the ESGAR, EAES, EFISDS and ESGE","route":"/key-papers/paper-gallbladder-polyp-joint-guideline-eur-radiol-2022/"},{"id":"paper-szpakowski-gallbladder-polyps-20-year-cohort-jama-netw-open-2020","kind":"paper","name":"Outcomes of Gallbladder Polyps and Their Association With Gallbladder Cancer in a 20-Year Cohort","route":"/key-papers/paper-szpakowski-gallbladder-polyps-20-year-cohort-jama-netw-open-2020/"},{"id":"paper-loeb-overdiagnosis-overtreatment-prostate-eur-urol-2014","kind":"paper","name":"Overdiagnosis and overtreatment of prostate cancer","route":"/key-papers/paper-loeb-overdiagnosis-overtreatment-prostate-eur-urol-2014/"},{"id":"paper-wilt-pivot-prostatectomy-observation-nejm-2017","kind":"paper","name":"PIVOT: follow-up of prostatectomy versus observation for early prostate cancer","route":"/key-papers/paper-wilt-pivot-prostatectomy-observation-nejm-2017/"},{"id":"paper-wennmacker-gallbladder-polyp-size-threshold-surg-endosc-2019","kind":"paper","name":"Polyp size of 1 cm is insufficient to discriminate neoplastic and non-neoplastic gallbladder polyps","route":"/key-papers/paper-wennmacker-gallbladder-polyp-size-threshold-surg-endosc-2019/"},{"id":"paper-welch-albertsen-psa-era-diagnosis-treatment-jnci-2009","kind":"paper","name":"Prostate cancer diagnosis and treatment after the introduction of prostate-specific antigen screening, 1986 to 2005","route":"/key-papers/paper-welch-albertsen-psa-era-diagnosis-treatment-jnci-2009/"},{"id":"paper-plco-chest-radiograph-lung-cancer-mortality-jama-2011","kind":"paper","name":"Screening by chest radiograph and lung cancer mortality: the Prostate, Lung, Colorectal, and Ovarian (PLCO) randomized trial","route":"/key-papers/paper-plco-chest-radiograph-lung-cancer-mortality-jama-2011/"},{"id":"paper-uspstf-lung-cancer-screening-jama-2021","kind":"paper","name":"Screening for Lung Cancer: US Preventive Services Task Force Recommendation Statement","route":"/key-papers/paper-uspstf-lung-cancer-screening-jama-2021/"},{"id":"paper-bill-axelson-spcg-4-29-year-nejm-2018","kind":"paper","name":"SPCG-4: radical prostatectomy or watchful waiting in prostate cancer, 29-year follow-up","route":"/key-papers/paper-bill-axelson-spcg-4-29-year-nejm-2018/"},{"id":"paper-independent-uk-panel-on-breast-cancer-lancet","kind":"paper","name":"The benefits and harms of breast cancer screening: an independent review","route":"/key-papers/paper-independent-uk-panel-on-breast-cancer-lancet/"},{"id":"paper-moyer-uspstf-prostate-screening-ann-intern-med-2012","kind":"paper","name":"USPSTF 2012: screening for prostate cancer, recommendation statement (grade D)","route":"/key-papers/paper-moyer-uspstf-prostate-screening-ann-intern-med-2012/"},{"id":"paper-uspstf-prostate-screening-jama-2018","kind":"paper","name":"USPSTF 2018: screening for prostate cancer, recommendation statement (grade C at 55 to 69, grade D at 70 and over)","route":"/key-papers/paper-uspstf-prostate-screening-jama-2018/"}],"cancer":[{"id":"lung-cancer","kind":"cancer","name":"Lung cancer (all types)","route":"/cancers/lung-cancer/"},{"id":"prostate","kind":"cancer","name":"Prostate cancer","route":"/cancers/prostate/"}],"idea":[{"id":"idea-prostate-metastatic-presentation-as-the-screening-endpoint","kind":"idea","name":"Judge a prostate screening programme on metastatic presentation, not on incidence or mortality","route":"/ideas/idea-prostate-metastatic-presentation-as-the-screening-endpoint/"},{"id":"idea-gbc-risk-targeted-ultrasound-in-high-incidence-regions","kind":"idea","name":"Risk-targeted ultrasound screening in high-incidence regions, tested against usual care","route":"/ideas/idea-gbc-risk-targeted-ultrasound-in-high-incidence-regions/"}],"trial":[{"id":"erspc","kind":"trial","name":"ERSPC (European Randomized Study of Screening for Prostate Cancer)","route":"/trials/erspc/"},{"id":"goteborg-2","kind":"trial","name":"GÖTEBORG-2 (MRI-based prostate cancer screening)","route":"/trials/goteborg-2/"},{"id":"plco-prostate","kind":"trial","name":"PLCO, prostate component (Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial)","route":"/trials/plco-prostate/"},{"id":"tmist","kind":"trial","name":"TMIST (Tomosynthesis Mammographic Imaging Screening Trial)","route":"/trials/tmist/"}],"journal":[{"id":"jama-internal-medicine","kind":"journal","name":"JAMA Internal Medicine","route":"/journals/jama-internal-medicine/"}]}}