Clinical Decision-making for Incidental Findings on Routine Imaging in Primary Care: Balancing Early Detection and Overdiagnosis

Abstract Incidental findings on routine imaging are increasingly encountered in primary care due to the expanding use of diagnostic modalities. While such findings may facilitate early detection of clinically significant disease, they also pose substantial challenges related to overdiagnosis, unnecessary investigations, patient anxiety, and increased healthcare costs. This review examines the clinical implications of incidental findings and outlines evidence-informed strategies to support decision-making in primary care settings. A targeted narrative review of the literature was conducted using PubMed and major guideline repositories, focusing on studies addressing prevalence, risk stratification, clinical outcomes, and management approaches for incidental findings across commonly used imaging modalities. Evidence suggests that most incidental findings are benign and do not require intervention; however, a subset may warrant further evaluation depending on patient-specific risk factors and imaging characteristics. Structured approaches incorporating risk stratification, adherence to established guidelines, and clear communication with patients are essential to minimize harm while preserving the benefits of early detection. Effective management requires balancing diagnostic vigilance with restraint to avoid low-value care. Primary care clinicians play a central role in contextualizing incidental findings, guiding appropriate follow-up, and addressing patient concerns. Adopting a proportionate, evidence-based approach can improve patient outcomes, reduce unnecessary interventions, and optimize resource utilization.