INTRODUCTION:Breast density notification is now implemented in the United States and parts of Australia and Canada despite limited understanding of how it impacts women and their psychosocial health. This study explored the psychosocial impact of receiving a notification of dense breasts through a population-based breast cancer screening programme. METHODS:We interviewed 19 Australian women who indicated being anxious in a survey. This survey was part of the first randomised controlled trial aiming to quantify the psychosocial impact of breast density notifications. Semi-structured interviews were conducted over the phone and analysed thematically to provide nuance and perspectives on the psychosocial impact. RESULTS:The women were 42-78 years old and had diverse ethnic and educational backgrounds. Women generally perceived breast density notifications as valuable for making health decisions, citing female empowerment and the value of information in health. Women described experiences of immediate panic and worry as well as changes to their perceived individual risk of breast cancer. The breast density notification challenged women's previous perceptions of risk of breast cancer, leaving them to reinterpret their need for medical assistance. Women thus described an increased general awareness about breast cancer, which increased their likelihood of performing self-exams and attending breast screenings. DISCUSSION:While empowerment and increased vigilance in health might present positive strides for women's health, the derivative worry highlights the paradoxical value of health awareness and risk communication. This tension is important to consider in future notification practices and decisions on whether to implement breast density notification. PATIENT OR PUBLIC CONTRIBUTION:This study is based on interviews with 19 women who have lived experience with breast density information. The semi-structured interview guide allowed the women to influence what was considered important and relevant.

Most celebrities are not formally trained in evaluating medical evidence. Accordingly, their testimonials or endorsements may lack solid scientific backing, relying on 'anecdotal evidence', which can potentially convince consumers to seek unsafe or ineffective therapies. This is especially concerning when financial interests may inadvertently cloud judgement and generate personal endorsements of ineffective, or even harmful, medical interventions to the public. Cancer patients are particularly vulnerable to these messages, while the rest of the public is interested in avoiding life-threatening conditions such as cancer. Social media amplifies adverse consequences by allowing wide circulation and reach of such misleading information. In this paper, we showcase these trends, discuss the ethical considerations as well as implications for healthcare systems, and call for more effective scrutiny and enforcement of current regulation of celebrity testimonials and endorsements.

OBJECTIVES:Although the concept of overdiagnosis was first referenced in MEDLINE 100 years ago, consensus on a clear definition has been lacking. In 2021, the MeSH term "Overdiagnosis" was officially introduced, which defined the concept. A key goal of the new term is to improve the reliability of literature searches and enhance the conceptual understanding of overdiagnosis. METHODS:We conducted a systematic bibliometric review of all citations indexed under the MeSH term for "Overdiagnosis" in MEDLINE. We compared the citations with citations identified through a text-word search for overdiagnosis not indexed under the MeSH term. Searches were performed on 15 September 2024. RESULTS:We found that a higher percentage of citations indexed under the new MeSH term used it according to the definition compared with the text-word search (73.2% vs. 49.5%). The remainder used the term to describe misdiagnosis, false positives, and overtreatment. The citations indexed under the MeSH term were primarily descriptive in nature (68.7%), focusing on oncology (54.2%) and screening practices (31.2%). DISCUSSION:Despite advancements, the field of overdiagnosis is still in its early stages, with potential for expansion into studies addressing prevention and mitigation strategies. The introduction of the MeSH term has facilitated some degree of conceptual alignment. CONCLUSION:Our review provides insights into the current state of the overdiagnosis literature, emphasising prevalent themes and areas for further research, and improvements in MeSH indexing accuracy. Residual conceptual ambiguity surrounding overdiagnosis terminology and indexing practices may explain discrepancies in MeSH categorisation and definition adherence.

OBJECTIVE:To assess the comprehensiveness of the reporting of physical harms in colorectal cancer screening programmes (CRCSPs) in randomised controlled trials (RCTs) and systematic reviews (SRs). DESIGN:We conducted an overview of reviews, comparing the comprehensiveness of reporting of harms in SRs and RCTs with a recent SR conducted according to the PRISMA-harms extension, identifying 17 types of physical harm potentially resulting from CRCSPs. MAIN OUTCOME MEASURES:Proportion of the 17 types of physical harm reported per study (study coverage), across studies (outcome coverage) and the level of harm severity reported in RCTs and SRs. RESULTS:We identified 24 RCTs and 16 SRs investigating physical harms related to CRCSPs. The median study coverage was 4 and 3 out of the 17 types of harm, varying from 5.9-47.1% and 5.9-52.9% types of physical harm reported in RCTs and SRs, respectively. The median outcome coverage was 4 and 3 across RCTs and SRs, varying from 0-66.7% and 0-87.5% in RCTs and SRs, respectively. Of note, 4 types of harm were not reported in any of the identified SRs. Inconsistent definitions of harm in RCTs and SRs made it difficult to assess which levels of severity of harm that were reported in studies. DISCUSSION:Poor reporting of harms in RCTs was compounded in SRs. We found poor study and outcome coverage and considerable inconsistencies concerning how physical harms were defined in RCTs and SRs. The inconsistent reporting of harms may result in an underestimation of their magnitude in relation to CRCSPs, raising concerns about our current capacity to evaluate the safety of these programmes. Adequate use of existing guidelines for harm reporting in RCTs and SRs and international consensus on how best to define and measure harms in studies of CRCSPs is warranted.

Drawing on phenomenological concepts of embodiment and the theory of clinical judgment, we examine how radiologists navigate the inherent risk of overtesting and overdiagnosis in breast cancer screening. Based on 12 weeks of fieldwork at a breast radiology department, we explore how radiologists navigate clinical ambiguity when women are recalled for further diagnostics following an abnormal screening mammogram. Radiologists expressed a strong sense of ethical obligation and responsibility, shaped by the structural and moral expectations of the screening programme, which fostered a precautionary mindset. We show how radiologists draw on a combination of knowledge, experience, sensory input, and emotional reasoning to navigate these ethical responsibilities. This interplay of emotions, ethics, and diagnostic skill constitutes a form of embodied expertise, which we term the "expert eye". The expert eye enables radiologists to critically engage with guideline-based diagnostics and perform less defensive, context-sensitive practices in a high-stakes setting. Ultimately, we argue that this form of expertise plays a crucial role in bridging the epistemic gap of overdiagnosis and the fundamental inability to know about or predict the progression of ambiguous findings. Our analysis also highlights the complexity of managing overtesting and overtreatment in clinical practice and suggests that supporting subjectivity in medicine, through the use of the expert eye, may in fact allow clinicians to perform higher-value care.

IMPORTANCE: Social media is an influential source of medical information, but little is known about how posts discuss medical tests that carry potential for overdiagnosis or overuse. OBJECTIVE: To investigate how social media posts discuss 5 popular medical tests: full-body magnetic resonance imaging, the multicancer early detection test, and tests for antimullerian hormone, gut microbiome, and testosterone. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study assessed posts on Instagram and TikTok between April 30, 2015, and January 23, 2024, that discussed full-body magnetic resonance imaging, the multicancer early detection test, and tests for antimullerian hormone, gut microbiome, and testosterone. Using keywords on newly created accounts, posts were searched and screened until 100 posts for each test on each platform were identified (n = 1000). Posts were excluded if they did not discuss 1 of the 5 tests or were not in English or if the account holders had fewer than 1000 followers. MAIN OUTCOMES AND MEASURES: The main outcome was information about benefits, harms, and overall tone discussed in the post. All outcomes were summarized descriptively. Logistic regression was used to assess whether the use of evidence or the account holder being a physician or having financial interests influenced how tests were discussed. RESULTS: A total of 982 posts from account holders with a combined 194 200 000 followers were analyzed. Across all tests, benefits were mentioned in 855 posts (87.1%) and harms in 144 (14.7%), with 60 (6.1%) mentioning overdiagnosis or overuse. Overall, 823 posts (83.8%) had a promotional (vs neutral or negative) tone. Evidence was explicitly used in 63 posts (6.4%), personal anecdotes were used in 333 (33.9%), 498 posts (50.7%) encouraged viewers to take action and get the test, and 668 account holders (68.0%) had financial interests. Posts from physicians were more likely to mention harms (odds ratio, 4.49; 95% CI, 2.85-7.06) and less likely to have an overall promotional tone (odds ratio, 0.53; 95% CI, 0.35-0.80). CONCLUSIONS AND RELEVANCE: In this cross-sectional study of social media posts about 5 popular medical tests, most posts were misleading or failed to mention important harms, including overdiagnosis or overuse. These data demonstrate a need for stronger regulation of misleading medical information on social media.

Testosterone has long been advertised through gendered messages that link masculinity with strength, sexual performance and vitality. In recent years, this marketing has moved onto social media, where platforms offer new ways to target audiences and shape ideas about men’s health. This study examines how gender and masculinity are portrayed in social media content about testosterone testing and treatment on Instagram and TikTok. Using qualitative content analysis informed by performativity theories, we constructed four themes: (1) low testosterone as a crisis of masculinity and male sexual performance; (2) the rebranding of low testosterone from an “old man’s problem” to an issue affecting younger men and their fitness; (3) self-optimisation tied to stereotypical masculine ideals; and (4) the construction of a binary opposition between being a “real man” and being feminine. These portrayals align with wider online communities, often referred to as the “manosphere”, which circulate narrow and exclusionary ideas of masculinity and regressive ideas and attitudes towards femininities. The analysed social media posts prey on men’s insecurities about relationships and sexual performance and co-opt advocates' emancipatory language to sell testosterone products. Such portrayals of masculinity have medicalising implications for how men perceive themselves and their mental health, but also promote capitalistic practices like consumption of testosterone products for improving the masculine self without supporting evidence.

OBJECTIVES:Receiving a false positive in colorectal cancer screening is associated with psychosocial consequences, yet the reasons why some people are more affected than others remain unclear. This study examines the association between sociodemographic factors and psychosocial consequences among screening participants with false positives in colorectal cancer screening. DESIGN:Prospective cohort study. PARTICIPANTS:1432 screening participants with positive faecal immunochemical test (FIT) screening with a follow-up colonoscopy with either no abnormalities or benign polyps (low or medium-high risk). OUTCOME MEASURES:We measured psychosocial consequences with the Consequences Of Screening - ColoRectal Cancer (COS-CRC) questionnaire, after the positive FIT but before the follow-up colonoscopy and again 1 year later. Sociodemographic factors were obtained from national registers and included sex, age, urbanicity, educational level, occupational status, income, assets, cohabitation status and Charlson Comorbidity Index. Psychosocial consequences were measured before colonoscopy (baseline) and 1 year after, and sociodemographic factors were assessed at baseline. RESULTS:We tested 19×2×3=114 associations between the sociodemographic factors and psychosocial consequences within the three groups of false positives and five associations were significant. We found that for participants with medium- and high-risk polyps, experiencing short-term psychosocial consequences was significantly associated with having a university degree compared with secondary school (OR=5.04 (1.38; 18.37), p=0.0142) and being unemployed compared with being employed (OR=5.61 (1.42; 22.14), p=0.0139). For participants with low-risk polyps, long-term consequences were significantly associated with the mid-income quartile (OR=2.32 (1.13; 4.76), p=0.0224) and the highest income quartile (OR=5.47 (1.13; 26.48), p=0.0349) compared with the lowest quartile. For participants with no abnormalities, there was an association between short-term psychosocial consequences and having comorbidities compared with none (OR=2.95 (1.13; 7.71), p=0.0277). CONCLUSION:This study found few significant associations between psychosocial consequences and sociodemographic factors and with no apparent pattern in these. This suggests no strong evidence that specific sociodemographic groups should be especially vulnerable to experiencing psychosocial consequences after a false-positive result from colorectal cancer screening. Thus, there is currently weak evidence for identifying screening participants at higher risk for psychosocial consequences and developing targeted interventions to reduce psychosocial consequences.

BACKGROUND:Misleading information about medical products on social media may cause overuse. OBJECTIVES:Explore interventions targeting the problem of misleading medical information and marketing on social media, with a focus on preventing medical overuse including overdiagnosis. ELIGIBILITY CRITERIA:We included peer-reviewed studies with original data on an intervention targeting misleading medical information on social media and governmental/institutional responses with and without evaluation. We excluded responses relating to COVID-19. SOURCES OF EVIDENCE:four electronic databases: MEDLINE/PubMed, PsycINFO, Academic Search Complete and Web of Science, and searches of grey literature on Google and Google Scholar. Search date: 9 June 2025. DATA CHARTING:We used prespecified data forms populated in duplicate by two reviewers. RESULTS:We identified 27 peer-reviewed articles and 25 organisational and governmental responses (grey literature). 20 (74%) of the peer-reviewed interventions targeted the consumer to enhance 'media literacy', support decision-making or warn about misinformation trends. Approaches included education, such as videos or information materials, to improve detection of misinformation, as well as correcting misinformation and rebutting claims. Only two (7.4%) of the peer-reviewed approaches were sensitive to the problem of medical overuse: a risk-of-deception tool and an informed decision-making service. The grey literature about government and organisational responses chiefly comprised general advertising regulations and other educational resources for consumers to identify and navigate misinformation. The advertising regulations ranged from self-regulatory codes of practice to mandatory regulations, requiring pre-approval of social media marketing material. Most regulations stated advertising should be truthful, presenting both benefits and harms and not be misleading. Most of the grey literature (64%) was sensitive to medical overuse, though none referred explicitly to the problem. CONCLUSIONS:Current efforts to address misleading medical marketing on social media often overlook the critical issue of medical overuse and fail to provide sufficient consumer protections in this rapidly evolving digital landscape of social media, such as the speed of dissemination, reach and the role of third-party advertising. These gaps in research, regulation and practice present significant opportunities to strengthen evidence-based policies and public health responses. TRIAL REGISTRATION DETAILS: https://doi.org/10.17605/OSF.IO/2NJSH.

BACKGROUND:Screening for gestational diabetes mellitus (GDM) in healthy pregnancies is disputed, and rising GDM incidence calls for an investigation into the potential for overdiagnosis. AIM:To identify and map empirical evidence on overdiagnosis in GDM screening and explore how different screening strategies impact overdiagnosis. METHODS:This review adheres to the JBI Manual and PRISMA-ScR guidelines. Systematic searches were performed on September 10th, 2024, without date, language, or geography restrictions, in Medline, Embase, CINAHL, Cochrane Library, and Web of Science. One search targeted studies explicitly addressing overdiagnosis through primary empirical analyses, while a second search included RCTs evaluating GDM screening programmes. Evidence screening and selection were carried out independently by two authors. FINDINGS:We included ten studies with varying designs in Search 1 and nine RCTs in Search 2. In Search 1, only one study defined overdiagnosis. In Search 2, seven of nine RCTs show an increased incidence with intensified screening. Of these, six evaluated universal screening and showed no accompanying benefits, suggesting overdiagnosis. Variations in strategies and outcomes complicate comparisons. Additionally, no RCTs compare screening to no screening or risk-based to universal screening, raising uncertainties about the effects of different screening programmes and practices. DISCUSSION:Our analysis of RCT data demonstrates that intensifying screening led to increased incidence without corresponding beneficial effects, indicating overdiagnosis. Few studies have assessed overdiagnosis empirically, and no established framework currently guides the definition or operationalisation of overdiagnosis in GDM screening research. CONCLUSION:Data from RCTs indicate overdiagnosis in universal GDM screening.

Objectives This study examines the association between participation in colorectal cancer screening and subsequent secondary healthcare use. Study design A prospective cohort study. Methods Exposure was based on a quasi-randomised screening implementation, with a 24-month follow-up. Outcomes included out-of-hospital specialist visits, hospitalisation, outpatient clinic visits, emergency room visits, colonoscopies and sigmoidoscopies, and prescription drugs. We employed a two-step model to estimate the relative risk and incidence-rate ratio of healthcare use, adjusted for baseline healthcare usage over the past decade and relevant socioeconomic factors. The results were stratified by screening results. Results Individuals with negative screenings were more likely to consult out-of-hospital specialists compared with a screening-naive control group. All screening groups had higher risk of hospitalisation, higher risk of using outpatient and emergency services, and higher risk of redeeming prescription drugs compared with the control group. Among those that used the respective services, it did not seem that screening groups had more visits or uses compared with the control group. Conclusions We observed an increase in healthcare use following colorectal cancer screening, suggesting that screening participants are referred more to secondary healthcare services.

BACKGROUND:For evaluation of breast cancer screening and informed prioritisation, it is important to examine the downstream healthcare use associated to participation. The objective of this study is to determine the healthcare use among breast cancer screening participants compared with screening-naïve controls. METHODS:The study is a register-based cohort study with 14 years of follow-up. We compare healthcare use among women who participated in the initial phase of the stepwise breast cancer screening implementation in Denmark (stratified on screening result: normal, false positive and breast cancer) compared with those invited in subsequent phases. RESULTS:Screening participants, especially those with false-positive results, tended to use primary healthcare services more than the screening-naïve group. Women with breast cancer and false positives received more breast imaging compared with the screening-naïve group. False positives consistently had the highest use of drugs compared with the control group. All screening groups had significantly higher use of outpatient clinic visits in the year of and following screening compared with the screening-naïve group. Screening groups were more likely to receive additional diagnoses in the years following screening than the screening-naïve group. There were no significant differences in medical procedures and days of hospitalisation. CONCLUSIONS:The study highlights differences in primary healthcare use among screening groups compared with the screening-naïve group. Since use of primary care services is at the discretion of the women, this implies increased worries about health. Thus, these results indicate increased healthcare-seeking behaviour, especially among women with false-positive results.

Objective This systematic review aimed to assess the evidence on sexual transmission of HIV in high-income settings between serodiscordant couples where the index partner infected with HIV is on antiretroviral therapy. Study design Systematic review and meta-analyses. Methods We performed a systematic search in four databases: Embase, MEDLINE, The Cochrane Library, and Web of Science on September 24, 2022. We assessed the risk of bias with ROBINS-I and pooled estimates in meta-analyses using a Poisson regression model with a random effect of the study and population size. The study protocol was pre-registered at PROSPERO. The study involved high-income countries. Results The search identified 6886 studies, of which six were included for review. Altogether, studies reported zero linked transmissions among 2383 couples, more than 160,000 acts of intercourse, and 3578 couple years. The risk estimate from overall meta-analyses was 0.000 95%CI (0.000–0.103) per 100 couple-years. Conclusion This systematic review and meta-analyses provide epidemiological evidence for a low risk of HIV transmission under antiretroviral therapy in high-income countries and thus cannot reject the theoretical "treatment as prevention" paradigm.

Objectives We aimed to systematically identify and scrutinise published empirical evidence about overdiagnosis in malignant melanoma and examine how frequent overdiagnosis of melanoma is and whether this is related to different types of interventions or diagnostic technologies. Design and setting Empirical studies that discussed overdiagnosis in malignant melanoma were eligible, including qualitative and quantitative studies in any type of population, age group and geographical location. We excluded studies that did not include empirical data, studies that only mentioned ‘overdiagnosis’ without addressing it further and studies that used the term overdiagnosis for cases of misdiagnosis or false positives. We developed the search strategy in cooperation with an information specialist. We searched five databases on 21 April 2022: MEDLINE, Embase, CINAHL, PsycINFO and Cochrane Library. This scoping review adheres to The JBI methodology and Prefered Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping reviews (PRISMA-ScR). Two reviewers independently screened titles, abstracts and full texts for inclusion and extracted data from the included studies. The data extracted include study characteristics, population details, research question, the context and the study’s main results. Results Our search resulted in 1134 potentially relevant studies. 35 studies were included: 29 register studies, 3 cohort studies, 1 case–control study, 1 survey study and 1 randomised controlled trial. Most register studies examined trends in melanoma incidence and/or mortality and found a significant increase in incidence between 0.39% and 6.6% annually and a little or no increase in mortality. Three cohort studies and one case–control study showed that skin screening was associated with increased detection of melanoma; especially in situ or thin invasive melanoma. Three studies estimated the degree of overdiagnosis which ranged from 29% to 60%. Conclusions Epidemiological data suggest a high degree of overdiagnosis in malignant melanoma. Studies that examined the association between skin screening and malignant melanoma all found increased detection of melanomas, mostly thin and in situ melanomas, which raises concern about overdiagnosis.