• over-diagnosis
• kawasaki disease

Coon et al,1 who have published on other areas of putative overdiagnosis, bring us the example of coronary artery abnormalities in Kawasaki disease in children. Across 48 participating hospitals, they noted that over some 15 years the rate of diagnosis of non-severe cardiac abnormalities had increased significantly by some twofold, yet adverse cardiac outcomes remained stable. Their contention is that this may represent an increasing rate of overdiagnosis and that if this is the case, some children may be unnecessarily exposed to potential harm. The issue of overdiagnosis in all age groups has received increased attention recently,2 3 so in this Editorial I will explore some of the issues as they relate to child health and consider the societal, cultural and professional drivers.

Overdiagnosis has no formal definition,4 5 but for the purpose of this piece, we can think of it as ‘the finding of mild disease for which the harms in diagnosing and treating exceed the benefits’. Nor is the issue a new one: Black and Welch published their landmark paper on the overestimation of disease prevalence 25 years ago, and even then they saw the problem as having crept up over the previous two decades.6 For fairly obvious reasons the issue has been of particular concern to radiologists as techniques and modalities have become progressively more refined, so more things are found on imaging that are not necessarily diseases. …