The Liability of Knowing Too Much: Overdiagnosis in the Digital Age

For centuries, society has aimed to empower individuals to live healthy lives and provide resources to detect, diagnose, and manage public health. Technology in recent years has significantly progressed, and innovations such as AI, machine analysis, and other digital tools that analyze images like CT scans and MRIs have dramatically increased the accuracy of diagnoses for patients on a global scale. Additionally, advocacy for diagnostic testing is on the rise, both politically and digitally. Legislation such as the Affordable Care Act has removed the economic barriers to receiving preventative testing, and healthcare officials and patients alike have taken to social media platforms like Facebook and TikTok to attest to the importance of timely screenings. While these new technological advances and increased awareness have been successful in detecting harmful health conditions at an early stage, an unexpected, unwanted controversy has stunned the world of healthcare: overdiagnosis. Overdiagnosis occurs when a patient is diagnosed and treated for a condition that would not have otherwise caused harm to the body. The crisis of overdiagnosis in the United States has caused harmful physical and mental side effects for patients; therefore, medical professionals must focus on reaching equilibrium between the levels of treatment given to patients as well as assisting patients in making informed decisions about their bodies.

Within the medical community, healthcare professionals are reporting concerns that too many people are being overdiagnosed and overtreated, a new development accompanied by the increasingly impressive abilities of scans to detect early abnormalities. These abnormalities are so small that they are usually benign and would not cause physical harm to a patient. Diagnostic screenings are one of the largest factors in overdiagnosis. For example, scanning for several cancers such as melanoma, thyroid, and breast cancer can reveal “incidentalomas,” or incidental findings of masses from unrelated screenings. Currently, these incidentalomas, which are benign and not required to be treated, are treated anyway, causing adverse effects and harm to patients. The consequences of excessive diagnosis from scanning can be seen from the rate of thyroid cancer diagnoses from 2000 to 2005, which increased by 22.5% (Moynihan). While the number of diagnoses has increased sharply, the number of deaths from the condition is stagnant. The disproportionate difference between the rate of diagnosis and death rates indicates an issue of overdiagnosis in thyroid cancer because an increase of diagnoses is not shown to impact the mortality rates (Moynihan). In addition to thyroid cancer, breast cancer is statistically one of the largest disproportionately diagnosed cancers. A review by Lancet Oncology in 2007 found that the proportion of overdiagnosis of breast cancer among women in their 50s ranged from 1.7% to 54%. Another systematic review in the British Medical Journal estimated that up to one third of screening detected cancers may be overdiagnosed. Several other conditions such as asthma, attention deficit hyperactivity disorder, and chronic kidney disease show similar patterns of overdiagnosis, caused by both an increase in screenings and widening of diagnosis criteria, leaving millions of patients affected by possible physical and neurological harms of overdiagnosis. Although the issue of overdiagnosis is not discussed widely by the public, medical professionals have begun to recognize the downsides of overdiagnosis and seek to articulate the extent of the problem, identify causes, and create changes in healthcare that lower the negative effects. 

One of the largest observed harms noted by healthcare officials is physical side effects from treatment, originating from medicine or various forms of invasive processes such as radiation or chemotherapy. Tumors, a largely overdiagnosed condition due to early detection, are treated with various therapies such as chemo and radiation therapies, regardless of its likelihood of causing harm of to an individual. Although radiation therapy is undoubtedly a vital aspect to destroying malignant tumor cells and saves many lives, the significant risks are undeniable. Radiation therapy targets cancerous cells by damaging their DNA and inhibiting them from reproducing, but in the process, healthy cells can be damaged as well. The harm to healthy cells can cause great discomfort to patients and cause unnecessary side effects if the tumor never progressed into an aggressive state. Hafsa Majeed, affiliated with Icahn School of Medicine at Mount Sinai, Elmhurst Hospital, describes the adverse effects of radiation therapy to be vast. In the nervous system, symptoms include “fatigue, loss of appetite, nausea, vomiting, headaches, hearing loss, and worsening neurologic symptoms” (Majeed). Irradiation to ovaries can also lead to “infertility or premature ovarian failure at low doses with increased sensitivity with advancing age” (Majeed). Beyond a few of these harmful side effects that can occur from radiation therapy, treating a benign growth with radiation can put patients at risk for developing a real, life-threatening cancer that never would have formed if they had not received treatment in the first place. Researchers attribute radiation to inducing secondary malignancies between “0.2% to 1% each year in cancer survivors” after receiving radiation therapy (Majeed). Given the 4 million people in the United States who received radiation therapy in 2024, according to Majeed’s estimation of the number of secondary malignancies that occur, an estimated 40,000 people were at risk of developing a secondary malignant tumor caused by radiation. Assuming a significant percentage of these treatments are resulting from an overly cautious diagnosis, the severe and mortal risks of side effects from radiation therapy from a benign tumor are entirely unnecessary. An additional method of removing abnormalities in the body, tumor resection surgery, comes with its own complications as well. Removing an abnormal mass from the body has significant risks such as internal bleeding, swelling, infection, and scarring that could lead to long-term implications. According to the Norwegian Stomach Cancer Trial in which patients underwent removal surgery for gastric cancer, “twenty-eight percent of the patients had one or more complications … [and] the postoperative morality rate for resected patient was 63 of 763” patients (Haugstevdt). Although the benefits may outweigh the risks for patients who suffer from malignant tumors, patients who were unnecessarily diagnosed will face complications from removal surgery that they should not undergo in the first place. Overall, complications from several risky forms of removing tumors are an example of the harmful implications overdiagnosis can have on patients, and the harm of treatment greatly outweighs the importance of cautious, early detection. 

Besides overdiagnosis causing detrimental physical effects, there are several psychological implications tied with the newly emerging crisis. One commonly studied effect, known as the nocebo effect, is a phenomenon manifested by bodily changes that can cause adverse health-related consequences. Many individuals are familiar with the placebo effect, in which drugs and treatment that cannot be attributed to having beneficial properties in them cause beneficial effects in the patient, due to personal expectation of improvement. Conversely, nocebo effects occur from interactions between clinicians and patients as well as the psychological state of the patient. In a conducted study, a group of healthy subjects were given a sham radiofrequency stimulus and told that the electrical stimulus would give them a headache. The patients reported “discomfort and head pain” caused by the expectations of a negative response (Colloca and Miller). The nocebo effect, as seen in Colloca and Miller’s experiment, implies that if a patient is diagnosed with a condition and the physician frightens the patient by explaining it in a poor way, the patient will begin to believe subconsciously that they are ill due to expectation. The result of the nocebo effect is typically to undergo unnecessary intervention that potentially harms the patient more than benefits their bodies. Beyond the field of oncology, overdiagnosis has led to an epidemic of unnecessary treatments in common psychiatric disorders such as attention-deficit hyperactivity disorder (ADHD). ADHD is a real and recognized condition, and increased awareness has led to more people seeking diagnosis. This awareness, accompanied by broadened diagnostic criteria, has facilitated an upward trend in people diagnosed with the condition. Although diagnosing ADHD is highly important to foster an easier lifestyle for those who have the condition, certain groups of patients are statistically more likely to be diagnosed with ADHD in unproportionate amounts. According to a study conducted by Todd E. Elder, a professor at Michigan State University, diagnoses of ADHD in young children are “driven largely by subjective comparisons across children in the same grade in school” (Elder). According to Elder’s study, children who are born within a month prior to the cutoff date for kindergarten eligibility, the youngest and developmentally immature children in the grade, are diagnosed with ADHD about 64.7% more frequently than other children in their grade. Diagnoses may be driven from psychological perceptions of poor behavior by teachers in the classroom, and these perceptions have “long-lasting consequences: the youngest children in fifth and eighth grade are nearly twice as likely as their older classmates” to take ADHD medication (Elder). These “symptoms” detected by teachers may not be accurately attributed to ADHD and instead reflect emotional and intellectual immaturity among youngest children in the classroom. ADHD is a textbook example of a trend in overdiagnosis among specific groups of patients, and the stigma that arises from labeling a child with ADHD can contribute to negative mental and emotional consequences that last a lifetime. As seen by the controversial and unnecessary diagnosing of ADHD, especially among children, it is imperative that healthcare officials educate patients on the possible negative effects of making a diagnosis. Moreover, psychology not only plays a significant role in causing overdiagnosis to occur but also is affected negatively by those who are improperly diagnosed by healthcare professionals. 

Despite evidence of the psychological and physical impact that overdiagnosis has on patients, there are several claims that undermine the urgency of the current diagnosis situation that is so prominent in the healthcare system today. One popular misconception is that early detection always saves lives and that it is better to take serious precautions than regret it later. This misconception regarding overdiagnosis occurs because overdiagnosis and detection are not directly intertwined. Overdiagnosis specifically pertains to the treatment of conditions that would not directly cause any harm to the person’s body or mental state. The treatment of harmless conditions does not save lives. Instead, it contributes to unnecessary psychological and physical risks that eventually do more harm to the patient than good. Early detection is undoubtedly vital to the proper treatment of millions of people per year. However, the interpretation of these detections and screenings should occur differently than they have been in recent years due to the increased ability of technological detections. It is important for medical professionals to achieve a proper balance in the action they take to treat their patients as well as educate them on terms that patients may face discomfort from. If a medical practitioner detects an abnormality from a screening, then they should “evaluate methods of observing changes to some suspected pathologies over time, rather than intervening immediately” (Moynihan). In other words, abnormalities should not be immediately treated but rather monitored for additional advancement because it allows practitioners to know when a condition should be dealt with based on a higher confidence level. Another claim many individuals have presented is that the more a person knows about their health, the better. While this notion is mostly valid, professionals must convey their knowledge and information about a patient intentionally. Autonomy over a patient’s health should not only be respected but also properly informed. Under the American Medical Association Code of Medical Ethics, the code states that healthcare workers “must disclose relevant medical information fully and accurately to patients and must make sure the patient understands the information presented.” This ethical standard asserts the idea that while physicians must prevent all relevant medical information as accurately as possible, they must ensure that the patient comprehends the information, keeping the information as proportionate to the medical situation as possible. Patients and physicians overall must increase proper communication to avoid the unnecessary risks of overdiagnosis and make informed, timely decisions. 

The medical field has already begun to provide a platform to increase awareness and develop ways to prevent the issue of overdiagnosis. Overdiagnosis is “now recognized as the future scientific direction of the National Cancer Institute’s division of cancer prevention in the United States” (Moynihan). This conference aims to provide researchers working in the field with methods to share and debate methods of combatting overdiagnosis. Regarding clinical practice, professionals suggest that the thresholds that define abnormalities in breast and thyroid cancer are raised in screening. Raising thresholds would prevent the number of patients treated at an excessively early time and encourage doctors to observe growth of tumor cells and make decisions at a proper time. Ultimately, the challenges that lead to overdiagnosis must be addressed via discussion among medical practitioners and researchers in conferences and other professional settings. Beyond discussions between professionals, physicians must properly educate patients to help them make more informed decisions about when a diagnosis may do more good than harm. 

Due to the harmful psychological and physical effects of diagnosis that patients have undergone in the past few years, it is imperative that medical professionals reach a healthy balance of treatment they administer to patients. The concrete solution to overdiagnosis is unfamiliar and difficult to discover given the newness of this medical concern, but in the meantime, patients must be treated based on what is best for them, all risks considered from several perspectives. Proper communication between physicians and patients must occur so patients can make informed decisions based on their understanding of the diagnostic results. Medical knowledge and innovation have greatly improved in recent years and saved the lives of many, but as society adjusts to the digital age, professionals must consider the new knowledge and interpret it correctly as well as continue the purpose of healthcare: maintaining a high quality life for individuals and populations.

Sources

Moynihan, Ray, et al. “Preventing Overdiagnosis: How to Stop Harming the Healthy.” The BMJ, vol. 344, British Medical Journal Publishing Group, 29 May 2012, www.bmj.com/content/344/bmj.e3502.

Majeed, H., and V. Gupta. "Adverse Effects of Radiation Therapy." StatPearls, edited by Amirhossein Mohebati, StatPearls Publishing, 2025, https://www.ncbi.nlm.nih.gov/books/NBK563259/.

Viste, A et al. “Postoperative complications and mortality after surgery for gastric cancer.” Annals of surgery vol. 207,1 (1988): 7-13. doi:10.1097/00000658-198801000-00003

Colloca, Luana, and Franklin G Miller. “The nocebo effect and its relevance for clinical practice.” Psychosomatic medicine vol. 73,7 (2011): 598-603. doi:10.1097/PSY.0b013e3182294a50

Todd E. Elder, et al. “The Importance of Relative Standards in ADHD Diagnoses: Evidence Based on Exact Birth Dates.” Journal of Health Economics, North-Holland, 17 June 2010, www.sciencedirect.com/science/article/abs/pii/S0167629610000755?via%3Dihub.