Table 1.

Common approaches used to promote earlier or increased detection of disease and what to consider

APPROACH TO EXPAND DISEASE DETECTION	REFLECTION
Expand the age range of screening to start earlier or end later	Incidence of the disease may differ or competing morbidity and mortality may worsen the benefit-harm balance. Examples include the controversy over the age to start screening for breast cancer with mammography. Transparent information about the magnitude of benefits and harms is key to shared decision making
Increase the frequency of screening	Belief in the benefit of more frequent screening to not “miss” cases while not considering the potential harms (eg, annual Papanicolaou tests were once thought necessary)
Use more sensitive screening tests	Use of more sensitive imaging may identify smaller lesions without evidence of benefit from clinical trials. An example would be if magnetic resonance imaging were recommended instead of mammography for breast cancer screening in women at average risk
Expand disease definitions	Lowering the threshold for abnormality will increase the proportion of the population diagnosed with a given condition. Examples include changes in the criteria for hypertension, diabetes, and autism spectrum disorder16