{
  "abstract": "Decades of international experience in systematic breast cancer screening have highlighted the risk of overtesting and overtreatment, largely attributed to false-positive screenings and overdiagnosis. Overdiagnosis represents an epistemic gap, as we are unable to know if diagnosed breast cancer will progress, and when we treat diagnosed breast cancer, we will never know if the person benefitted from that treatment. This represents a challenge in clinical practice and screening, where the detection of conditions leaves both patients and healthcare professionals in situations where they are aware of the condition but do not know the phenomenal truth about it. As radiologists analyse high-resolution images and detect smaller lesions, they are faced with an urgent need to navigate the fine balance between avoiding overtesting while also detecting cancers at a localised stage to improve prognosis.Based on 12 weeks of fieldwork at a breast radiology department, I examine the complexities radiologists face in their diagnostic practice, especially attending to the risk of overtesting and overdiagnosis and how this is negotiated in practice.Implementing a breast cancer screening programme imposed ethical responsibilities on the radiologists, which together with the guidelines fostered a general precautionary approach to diagnostics. However, the radiologists employed a combination of different types of knowledge, experience, sensory input, and emotional reasoning to navigate these ethical responsibilities. For instance, the radiologists considered the potential psychological impact of testing and recommended follow-up examinations over biopsies in low-risk cases. Others deviated from guidelines to avoid overly cautious practices in low-risk ambiguous cases: ‘Due to the refined techniques, you have to learn when to turn a blind eye’. This demonstrates a form of embodied expertise that integrates emotions, experience, and ethics with diagnostic skill. This expertise represents a particular virtue of radiologists which allows them to distance themselves from a precautionary approach and helps them navigate the risk of overtesting and such epistemic activities in diagnostic practice.This analysis questions the validity of using adherence to guidelines as a quality indicator. Focusing on adhering to guidelines could remove the freedom of subjectivity in medicine and encourage defensive practices, thereby increasing the risk of overdiagnosis through overtesting. Radiologists could account for overtesting, while overdiagnosis remained elusive once an abnormality was detected by biopsy and tissue diagnosis. Although overtesting is linked to overdiagnosis, overdiagnosis was not explicitly considered in clinical decision-making and thus overdiagnosis remains an etic concept.",
  "authors": [
    {
      "affiliations": [
        "Center for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark"
      ],
      "name": "Emma Grundtvig Gram"
    }
  ],
  "title": "080 Navigating the risk of overtesting and overdiagnosis in clinical breast radiology",
  "uid": "11e81a09-f279-5677-9398-41e2ceeabc8e"
}