Overdiagnosis and Overtreatment: Balancing Risks and Benefits in Value-Based Medicine

Overdiagnosis and overtreatment are increasingly recognized phenomena in modern medical practice. These terms refer to the identification and treatment of conditions that would not cause symptoms or death if left undetected. In a context of defensive medicine and growing patient pressure, physicians face the challenge of balancing the risks and benefits of medical interventions. This balance is crucial to avoid the negative clinical implications that can arise from unnecessary treatment.

Diving Deeper into Overdiagnosis and Overtreatment

Overdiagnosis is a significant issue in various areas of medicine. For instance, in the case of prostate cancer, the use of prostate-specific antigen (PSA) testing has led to an increase in the diagnosis of cancers that may not have caused harm during the patient's lifetime. This has resulted in significant overtreatment, with adverse effects on patients' quality of life, such as erectile dysfunction and urinary incontinence [1].

In the realm of mental health, screening for depression in children and adolescents also raises concerns about overdiagnosis. A recent study highlights the need to carefully evaluate the benefits and harms of formal screening in primary care to avoid labeling and treating young individuals who may not require intervention [2].

Technology also plays a role in this dilemma. Computer-aided detection during colonoscopy, for example, has improved adenoma detection rates but has also increased the unnecessary removal of non-neoplastic polyps, representing a risk of overtreatment [3].

Conclusions

To address overdiagnosis and overtreatment, it is essential to adopt a value-based medicine approach. This involves carefully considering the tests and treatments we offer, ensuring they are supported by solid evidence and genuinely benefit the patient. The incorporation of more precise diagnostic tools, such as multiparametric MRI in prostate cancer, can help reduce the diagnosis of indolent cancers [4].

Ultimately, the goal is to provide healthcare that maximizes benefits and minimizes harm, thereby avoiding the negative consequences of overdiagnosis and overtreatment. Continuous education and open dialogue between physicians and patients are fundamental to achieving this balance.

Referencias

• [1] Prostate cancer overdiagnosis and overtreatment.
• [2] Screening for depression in children and adolescents: a protocol for a systematic review update.
• [3] Real-Time Computer-Aided Detection of Colorectal Neoplasia During Colonoscopy: A Systematic Review and Meta-analysis.
• [4] Prostate cancer screening-current overview.

Created 13/1/2025