The Digital Incidentaloma Appreciating and Managing the Hazards of Continuous Digital Monitoring.

Continuous digital health technologies are transforming diagnostic medicine by enabling repeated physiological surveillance outside traditional clinical settings. Smartwatches, wearable sensors, continuous glucose monitors, and other consumer-facing technologies can identify abnormalities in asymptomatic individuals with low pre-test probability of disease. We describe the 'digital incidentaloma' as an unsolicited or unexpected abnormality detected through consumer-facing digital surveillance, outside a specific clinical diagnostic question, for which the clinical significance or appropriate downstream response is uncertain. Unlike traditional incidental findings, digital incidentalomas arise from persistent interrogation of normal physiology and may represent biological variation, abnormalities of uncertain significance, measurement artefact, algorithmic misclassification, or clinically actionable disease. Their detection can initiate diagnostic cascades, increase healthcare utilization, contribute to patient anxiety, and shift responsibility and costs from technology developers to healthcare systems. Addressing digital incidentalomas requires risk-based clinical pathways, confirmation of potentially actionable findings using established clinical methods, appropriate validation of consumer technologies, proportionate regulatory oversight, and evaluation of consequences beyond diagnostic accuracy.