Advances in medical technology and the roll out of the “early detection-early diagnosis-early treatment” strategy have improved cancer outcomes, yet the problem of overdiagnosis to over treatment has become increasingly salient, forming a risk chain from over diagnosis to over treatment. The typical mechanisms include the proliferation of screening and downward shifts in diagnostic thresholds, which promote more aggressive and redundant interventions. For several cancers in China, the rates and impacts of overdiagnosis are, overall, higher than international reports. Underlying causes include lagging updates to guideline thresholds and weak evidence bases, pronounced tumor heterogeneity, uneven technological development, entrenched traditional beliefs, misaligned provider-patient behaviors and incentives, and governance gaps coupled with mismatched insurance incentives. Internationally, measures such as redefining low-risk lesions, expanding active surveillance, implementing the Choosing Wisely initiative, and advancing payment reform provide useful lessons. China has launched relevant responses, but gaps remain in sustainability and conflict-of-interest management. Accordingly, we recommend building a multi-stakeholder governance ecosystem: advance dynamic guideline updates and screening optimization; leverage health big data for risk-stratified regulation; strengthen health promotion and social co-governance; deepen shared decision-making; and refine insurance and compensation reforms. Through coordinated, end-to-end and multi-dimensional action, resource allocation can be optimized while maximizing patients’ net health benefit.
