De-diagnosing chronic lymphocytic leukaemia: An ethical and scientific case for changing diagnostic criteria

Abstract

Overdiagnosis describes situations where â??people are labelled with or treated for a disease that would never cause them harmâ??. We believe the current diagnostic paradigm for chronic lymphocytic leukaemia (CLL) constitutes overdiagnosis, imposing a diagnosis which can cause significant distress to patients without benefit. In this article, we begin with the personal experience of one of the authors (Peter Allen), which powerfully depicts the harms of a CLL label. We then consider the historical context of current CLL diagnostic criteria and question their suitability. Finally, we consider other possible approaches to CLL diagnosis, including intentional non-investigation and de-diagnosis.