Volume 112, Issue 3, Pages 448–449
Artur Ludwin, M.D., Ph.D., Wellington P. Martins, M.D., Ph.D., Bala Bhagavath, M.D., Steven R. Lindheim, M.D., M.M.M.
In As You Like It, Shakespeare's romantic comedy from the 1600s, when Rosalind is about to marry Orlando, she asks, “Why then, can one desire ‘too much’ of a good thing?” This issue of excess—“too much of a good thing”—can be traced back to the 1950s in health care. Overscreening of asymptomatic individuals often leads to overdiagnosis and overdetection. Overdiagnosis can used to refer to labeling a healthy person as having a disease after identifying a condition that was never going to cause harm. Overdiagnosis can occur as a result of overdetection, which has its genesis in performing very sensitive diagnostic testing that has poor specificity. In overdefinition of disease, normal conditions that were never going to cause harm may be labeled abnormal, or abnormalities that do not progress may be identified; or conditions that progress too slowly to cause symptoms or harm during a person's remaining lifetime—or may resolve that resolve spontaneously—may be targeted for treatment (1). Ideally, the definitions, criteria, and cutoffs for recognition of disease are evidence based and are related to health consequences.