Cancer Overdiagnosis and Overtreatment a National Problem
Jul 29, 2013 - 12:18:38 PM
The 3-member National Cancer Institute working group suggests that premalignant conditions, which are often identified through routine screenings for breast, prostate and other cancers, should be reclassified as IDLE (indolent lesion of epithelial origin) conditions.
"No doctor wants to overtreat a patient," said Ian M. Thompson Jr., M.D., director of the CTRC at the UT Health Science Center at San Antonio. "But in our eagerness to detect and fight cancer across the board as early as possible, we have developed a system that encourages that."
"Now we have the opportunity to refine that process so that it is truly effective," he said.
Overdiagnosis and overtreatment unnecessarily cost money and damage patient quality of life. In June JAMA published a study showing that many men are treated unnecessarily for prostate cancer. Today Dr. Thompson and the other members of the group address the problem on a broader scale. They suggest how the medical community can get a better handle on the problem as we learn more about which cancers need treatment and which ones call for watchful waiting.
The decades-long focus on screening and early treatment of cancer has not in itself led to an overall reduction in cancer mortality. But with all that screening has come a significant increase in detection of early-stage cancers. The many different types of cancers and their different paths of development mean some lead to metastases and death while others are "indolent" and will never actually harm the patient.
Understanding this gives us the opportunity to focus the screening process on deadlier cancers, the authors write. That will then focus resources where they will do the most good, and ease the burden of cancer screening and treatments among patients who don't need it.
To do this, the authors note, doctors, patients and the general public must recognize that overdiagnosis is common and occurs more frequently with increased cancer screening.
They also suggest reserving the term "cancer" "for describing those lesions that have a reasonable likelihood of lethal progression if left untreated." Premalignant conditions such as ductal carcinoma en situ (DCIS) in the breast should not be called cancer, and should be reclassified as IDLE (indolent lesions of epithelial origin) conditions, the authors say.
The medical community should create large registries for low malignant potential lesions, building data about tumor growth rates over time and providing access to information about alternative treatments such as watchful waiting that help patients and doctors make informed decisions.
And we should back off overdiagnosis, the authors write. That can be done several ways, including by reducing low-yield diagnostic evaluations, cutting back on the frequency of some screenings and focusing on high-risk populations.
The Cancer Therapy & Research Center (CTRC) at The University of Texas Health Science Center at San Antonio is one of the elite academic cancer centers in the country to be named a National Cancer Institute (NCI) Designated Cancer Center, and is one of only four in Texas. A leader in developing new drugs to treat cancer, the CTRC Institute for Drug Development (IDD) conducts one of the largest oncology Phase I clinical drug programs in the world, and participates in development of cancer drugs approved by the U.S. Food & Drug Administration. For more information, visit www.ctrc.net.
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