Avoiding overdiagnosis pitfalls

The issue of overdiagnosis in medicine has been brought to center stage by recent and proposed changes to screening guidelines for prostate and breast cancer. Overdiagnosis, however, is also a problem in the pediatric population, cautioned Eric Coon, MD, assistant clinical professor of pediatrics, University of Utah School of Medicine, Salt Lake City, Utah.

Speaking at a session on Saturday, October 24 titled “Overdiagnosis in pediatrics: we don’t always need to know,” he explained that overdiagnosis occurs when a true abnormality is identified, but there is no benefit to the patient from its detection.  

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The list of childhood conditions that are possibly overdiagnosed includes food allergy, hyperbilirubinemia, obstructive sleep apnea, swallowing difficulties, urinary tract infection, and vesicoureteral reflux. Not only might there be a lack of benefit from recognizing these disorders since they are unlikely to cause any clinically significant morbidity, but their evaluation and management results in unnecessary use of resources, contributing to the problem of high healthcare spending, and have the potential to inflict physical and psychological harms. 

The detrimental physical effects relate to the consequences accompanying unnecessary interventions. For example, obstructive sleep apnea is increasingly used as an indication for performing tonsillectomy. 

Psychological harms arise if the medical diagnosis changes the perception of the child by the parents/caregivers, society, and even the child himself. For instance, the child may become the subject of vulnerable child syndrome, a clinical state where parents have persisting concern about their child’s susceptibility to health and/or developmental problems despite full recovery from an illness. In the case of infants with jaundice for example, parents may be more likely to seek medical attention for their child for any emerging sign or symptom well after resolution of the hyperbilirubinemia, said Dr Coon.

Perceiving subsequent minor illnesses as being more serious than they are, parents may also fear leaving their baby with any other caregiver.

Dr Coon’s suggestion to providers, which extends to parents as well, is to carefully consider the potential long term harms and benefits to making a diagnosis before exposing a child to testing. 

“Rather than simply asking, ‘Will this test find an abnormality?’, we should ask ourselves, ‘Is the child likely to experience more benefit than harm as a result of this test and any subsequent diagnoses?’, Dr Coon said.