Cancer overdiagnosis and overtreatment a national problem

Posted: Monday, August 05, 2013

Physicians should make it a point not to overdiagnose cancer, but to distinguish between cancerous tumors and premalignant conditions, which are often identified through routine screenings for breast, prostate and other cancers. These should be reclassified as IDLE (indolent lesion of epithelial origin) conditions, said CTRC Director Ian M. Thompson Jr., M.D., and his colleagues in the <em>Journal of the American Medical Association</em> commentary. <em>Click on image for a larger view.</em>clear graphic
Physicians should make it a point not to overdiagnose cancer, but to distinguish between cancerous tumors and premalignant conditions, which are often identified through routine screenings for breast, prostate and other cancers. These should be reclassified as IDLE (indolent lesion of epithelial origin) conditions, said CTRC Director Ian M. Thompson Jr., M.D., and his colleagues in the Journal of the American Medical Association commentary. Click on image for a larger view. 

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Contact: Elizabeth Allen, 210-450-2020

SAN ANTONIO (July 29, 2013) – Increased cancer screening has made overdiagnosis and overtreatment bigger problems, and the term “cancer” should be reserved only for those lesions with a reasonable likelihood of lethal progression if left untreated.

This is the conclusion of a commentary in the Journal of the American Medical Association authored by a panel that includes the director of the Cancer Therapy & Research Center (CTRC).

The three-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.

Unnecessarily costly, uncomfortable for patients
Overdiagnosis and overtreatment cost extra money and damage patient quality of life. In June, JAMA published a study showing that many men are treated unnecessarily for prostate cancer. In their commentary, published in the July 29 edition of JAMA, 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.

Gauging the seriousness of the disease
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.

Refining the definition of cancer
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.

Other members of the NCI working group are corresponding author Laura J. Esserman, M.D., M.B.A., director of the Carol Franc Buck Breast Care Center at the University of California San Francisco, and Brian Reid, M.D., Ph.D., member of the Human Biology Division at Fred Hutchinson Cancer Center in Seattle, Wash.

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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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