Overdiagnosis in renal cancer: the hidden consequence of modern imaging

The global burden of renal cell carcinoma (RCC) has risen substantially over the past three decades, while mortality rates have remained largely stable. This epidemiologic paradox suggests that a significant proportion of detected renal tumors may reflect overdiagnosis. This review synthesizes current evidence on the magnitude, drivers, and implications of overdiagnosis in RCC, integrating epidemiologic trends, tumor biology, imaging practices, and translational advances. The widespread use of cross-sectional imaging, particularly computed tomography (CT) and magnetic resonance imaging (MRI), has markedly increased the incidental detection of RCCs, with more than 50% now diagnosed incidentally. Many of these small renal masses (SRMs) are benign or biologically indolent. While early detection may benefit patients with aggressive disease, it can also lead to overtreatment, psychological burden, and increased healthcare costs. Emerging strategies, such as active surveillance, radiomics, and artificial intelligence (AI)-based risk stratification, offer potential pathways to reduce harm. Addressing overdiagnosis is essential to advancing a more precise and clinically meaningful approach to RCC detection and management.