Overscreening, also called unnecessary screening, is the performance of medical screening without a medical indication to do so. Screening is a medical test in a healthy person who is showing no symptoms of a disease and is intended to detect a disease so that a person may prepare to respond to it. Screening is indicated in people who have some threshold risk for getting a disease, but is not indicated in people who are unlikely to develop a disease. Overscreening is a type of unnecessary health care.
Overscreening is problematic because it can lead to risky or harmful additional treatment when a healthy person gets a false positive result for screening which they should not have had. It also causes unnecessary stress for the person receiving the test, and it brings unnecessary financial costs that someone pays.
The general rule is that people should only be screened for a medical condition when there is a reason to believe that they ought to be screened, such a medical guideline recommendation for screening based on evidence from a person's medical history or physical examination.
Controversy and debate arise when new medical guidelines change screening recommendations.
Definition
Screening is a type of medical test which is done on health people who do not show symptoms of a medical condition. Screenings are correctly performed when done on a person who has significant risk of developing a medical condition, and incorrectly performed when done on a person whose risk is not significant.
There can be debate about when risk becomes great enough to become significant and merit a recommendation for screening, but in discussions about overscreening, this is not the cause of the problem. Overscreening almost always happens when a person is screened routinely and without any consideration of their risk for a medical condition.
One early use of the term "overscreening" as "unnecessary screening" was in 1992 in the context of cervical cancer screening.
A 1979 paper used the term "overscreening" to mean "false positive result in a screening".
Causes of overscreening
Same causes as unnecessary health care
Overscreening is a type of unnecessary health care, so the causes of unnecessary health care are also causes of overscreening. Some causes include financial biases for physicians to recommend more treatment in health care systems using fee-for-service and physician self-referral practices; and physicians' practice of defensive medicine.
Screening creep
Over time, recommendations to screen are made for populations with less risk in the past.
Clinical practice guidelines advise physicians to screen early to detect diseases. It has been considered that guideline committees might not appropriately do cost-effectiveness analysis, consider opportunity cost, or evaluate risks to patients when they broaden screening recommendations.
Diagnostic creep
Over time, the indicators for making a diagnosis are lower so that people with fewer symptoms are diagnosed with a disease sooner. Additionally, new diseases are named and treatment is recommended, including "subclinical diseases", "preclinical diseases", or "pseudodiseases", which are described as early versions of a disease which has not manifested.
Patient demand
Patient demand is a sort of self-diagnosis in which patients request treatment regardless of whether the treatment they request is medically indicated. Causes for patients requesting treatment include increased access to health information on the Internet and direct-to-consumer advertising.
Ethical concerns of screening under these circumstances have been described.
Distraction tricks by physicians
Physicians sometimes use screening as a placebo for patients who wish to have some kind of care. The physician may recommend screening to placate the patient's demand for fast recovery in times when the recommended action would be to do nothing except wait. Research suggests that patients are more satisfied with their treatment when it is or seems expensive because patients believe that the more care they get, even if it is not necessary, then at least doing something is better than doing nothing.
Arguments against overscreening
Overscreening is a type of unnecessary health care. One study about unnecessary screening before surgery reported that physicians order unnecessary tests because of tradition in the practice of medicine, anticipation that other physicians will expect the test results when they see the patient, defensive medicine, worries that a surgery may be canceled if the test is not done, and lack of understanding about when a test is actually indicated.