Stop Overdiagnosis: RVS Warns Against Unnecessary Cancer Patients

The Perils of Overdiagnosis: Are We Turning Healthy People Into Patients?

By Archyde News Journalist

April 15, 2025

A growing chorus of experts is warning that the relentless pursuit of early detection and diagnosis in healthcare is reaching a hazardous tipping point.This expansion, fueled by technological advancements and a risk-averse society, carries “significant disadvantages” that are often overlooked, according to a recent report, Everyone Almost Sick, from the Council for Public Health and Society (RVS). The report highlights a “worrying unlimited expansion” of screening and diagnoses, outpacing what can be explained by population growth and aging alone.

The core issue, experts argue, isn’t the availability of advanced medical technologies, but rather the balance between detecting potential health issues and the potential harm caused by overdiagnosis and overtreatment. This is especially relevant in the United States, where healthcare costs are already astronomical and the system is struggling to keep up with demand.

Former minister and RVS chair Jet Bussemaker emphasizes the need for a “counter-noise” in the public discourse. “only the positive sides are always emphasized. And if you give positive attention to something, it grows,” Bussemaker stated. She describes the report as “a message with a vrey big warning,” cautioning against the uncritical acceptance of ever-expanding screening programs.

This echoes concerns raised by organizations like the national Academy of Medicine in the U.S., which have long advocated for more judicious use of medical tests and procedures.

The Slippery Slope of “Diagnosis Exhibition” and “Diagnosis Inflation”

The RVS report uses stark terms like “diagnosis exhibition” and “diagnosis inflation” to describe the current trend. These terms highlight how increasingly sensitive diagnostic tools can identify minor abnormalities that may never actually cause harm. This can lead to a cascade of unneeded tests, treatments, and anxiety for individuals who are essentially healthy.

Bussemaker illustrates this point with the example of low back pain, a common ailment affecting more than half of the population at some point in their lives. “If there is appearance to the lower legs, an MRI scan is useful, because a pinched nerve in the back can be the cause,” the RVS writes. “But in the vast majority of cases, a scan is not useful. And often it happens anyway.”

The American College of Physicians, as a notable example, has published guidelines recommending against routine imaging for low back pain unless specific red flags are present, highlighting the potential for overutilization of these expensive and frequently enough unnecessary tests.This mirrors the RVS’s concern that healthcare professionals are increasingly inclined to reccommend tests “to know everything, never miss anything, and don’t have to get to the disciplinary court.”

The Ethical Minefield of Predictive Testing

The report also raises ethical questions about the increasing availability of predictive tests, such as those that can assess an individual’s risk of developing Alzheimer’s disease. While some may find this information empowering, others may experience significant anxiety and distress.

Does it contribute to the quality of life if someone knows that he might get alzheimer’s?

Bussemaker elaborates, “It can help for one, but the other can quickly scare it. That you immediately think a word or a name in everything, if you think: would the moment be there now? while we all forget a name or a word.”

This raises complex questions about informed consent and the psychological impact of receiving perhaps life-altering information about future health risks. It also underscores the need for robust counseling and support services for individuals undergoing predictive testing.

The Downside of Over-Screening: False Positives and Resource Depletion

The RVS report details numerous drawbacks to the current emphasis on widespread screening,including false positives,increased healthcare costs,overdiagnosis,and the potential displacement of resources from patients with more serious conditions.

The report is particularly critical of population-based screening programs for breast, colon, and cervical cancer, arguing that “the advantages are estimated too high, the disadvantages too low.” Bussemaker notes that “with breast cancer,70 percent of the references after screening is a false alarm. That causes anxiety, stress and uncertainty.”

This high false-positive rate not only causes emotional distress but also leads to further unnecessary testing and procedures, adding to the burden on the healthcare system. The U.S. Preventive Services Task Force (USPSTF) regularly updates its screening recommendations based on the latest evidence, attempting to strike a balance between the benefits and harms of early detection.

With breast cancer, 70 percent of the references after screening are a false alarm. That causes fear, stress and uncertainty

The Economic Impact: Healthcare Costs and Waiting Lists

The relentless pursuit of early diagnosis also has significant economic consequences. As Bussemaker points out, “People roll from one study to the other. That represents people with more serious complaints waiting for inquiry.” She adds, “A first investigation frequently enough causes a cascade of follow -up investigations… That leads to rising waiting lists, we want to stay as a staff, while there is already a. to follow?”

This “cascade effect” contributes to rising healthcare costs and longer waiting times for essential services. In the U.S., where healthcare spending already accounts for a significant portion of the GDP, the need for cost-effective and evidence-based healthcare practices is more pressing than ever.

The Power of Labels: Stigmatization and Self-Fulfilling Prophecies

The RVS report also highlights the increasing tendency to label individuals with milder forms of diseases or conditions,such as pre-diabetes or mild ADHD. While a diagnosis can provide some individuals with a sense of validation and understanding, it can also lead to stigmatization, exclusion, and lowered expectations.

Bussemaker explains, “For many people it is a relief if they get a diagnosis. That feels like recognition, so much: I am not crazy. In the short term that can be nice, but in the long term that can be harmful. You get a label, it can cause stigmatization, exclusion, and low expectations of yourself: ‘It all comes through my ADHD.'”

This phenomenon is particularly relevant in the context of mental health, where diagnoses can have a profound impact on an individual’s self-perception and social interactions. The potential for self-fulfilling prophecies, where individuals internalize their diagnoses and limit their potential, is a serious concern.

The Driving Forces Behind Diagnosis Expansion

The RVS report identifies a number of factors driving the expansion of screening and diagnosis, including:

• Risk-averse society: A desire to control and manage health risks as much as possible.
• High expectations of care: Unrealistic expectations about the ability of healthcare to prevent or cure all diseases.
• technological advancements: The availability of increasingly sensitive and sophisticated diagnostic tools.
• Financial incentives: Doctors and hospitals may be incentivized to perform more tests and procedures, even when they are not medically necessary.
• Patient expectations: Patients may demand tests and treatments, even when they are not indicated.
• Commercial interests: Pharmaceutical companies and medical device manufacturers have a financial interest in promoting the use of their products.
• Patient advocacy groups: A broader definition of a disease such as ADHD leads to a larger group that they represent.That contributes to their visibility and impact, they can generate more social attention.

Driving Force	U.S. Example	Potential Consequence
Risk-Averse Society	Increased demand for genetic testing for predispositions to diseases.	Anxiety, unnecessary preventative measures.
High Expectations of Care	Requests for antibiotics for viral infections.	Antibiotic resistance, adverse drug effects.
technological Advancement	Widespread use of advanced imaging (MRI, CT scans).	Overdiagnosis, radiation exposure, increased costs.
Financial Incentives	Fee-for-service model encourages more procedures.	Unnecessary surgeries, higher healthcare spending.
Commercial Interests	Direct-to-consumer advertising of prescription drugs.	Inappropriate medication use, increased costs.

Bussemaker notes that “Doctors want to know everything, never miss anything, and don’t have to get to the disciplinary court. That can quickly lead to: do a laboratory test,do an MRI. Lap time also plays a role. Often it takes more time to explain why treatment is not the best solution, so do it. It also yields money too.”

People roll from one study to the other. That represents people with more serious complaints waiting for investigation

Moving Forward: A Call for a More Balanced Approach

The RVS report calls for a fundamental shift in the way we approach healthcare, moving away from a relentless pursuit of early detection towards a more balanced and evidence-based approach. This includes:

• promoting healthier lifestyles: Encouraging individuals to adopt healthy behaviors to reduce their risk of developing chronic diseases.
• Improving interaction between doctors and patients: Ensuring that patients are fully informed about the benefits and risks of screening and treatment options.
• Developing more accurate and reliable diagnostic tools: Reducing the risk of false positives and false negatives.
• Reforming healthcare payment models: Aligning financial incentives with the delivery of high-quality, cost-effective care.
• Raising public awareness: Educating the public about the potential harms of overdiagnosis and overtreatment.

Bussemaker concludes by emphasizing the importance of promoting overall health and well-being, rather than simply labeling individuals as “sick” or “almost sick.” She argues that “We want to go to a society where everyone is healthy, but what we actually do is a label of sick or almost sick. That is very contradictory.”