Experts say 'cancer' overdiagnosed, overtreated

A panel of scientists from the National Cancer Institute is recommending changes in how one of the most dreaded diseases is defined and treated, calling for the elimination of the word “cancer” in some diagnoses in order to curb patients’ anxieties over slow-growing forms of the ailment that may lead them to push for unnecessary or harmful treatments.

The NCI panel summarized its recommendations in an article published Monday in the Journal of the American Medical Association, focusing on what they say is the overdiagnosis of certain kinds of nonfatal, slow-growing tumors. Increased cancer awareness and cancer screenings have led to surges in early-stage cancer diagnoses in recent decades, but later-stage cancers haven’t proportionally decreased along with those screenings and early detection, the panel says.

“It’s time for us to change our plan from our old idea, which was a good one: If we can just detect cancer early, we can cure it,” said Dr. Laura Esserman, a surgery and radiology professor at University of California, San Francisco, and director of UCSF’s Carol Franc Buck Breast Care Center, and who wrote the JAMA article. “It turns out that there are several different ways that cancer grows. It turns out that cancer is not just one disease; it’s many diseases.”

In other words, cancer is a broad term, and some fast-growing types are fatal while others don’t cause patients significant harm.

But because the word “cancer” is so loaded, “cancer is still perceived as a diagnosis with lethal consequences if left untreated,” the authors write, causing doctors to feel like they should treat cancers that are unlikely to ever harm patients.

For some types of cancer, the polyps and precancerous growths detected in screenings are so slow-growing that they’ll never do enough damage to a patient to justify surgery or other treatments, and such steps could actually do more harm than good, according to Esserman. So frequent screenings or aggressive treatments for those types of cancer are unnecessary.

“The problem with the public is, they think, when they hear the word ‘cancer,’ that every cancer will kill you unless you treat it aggressively,” Esserman said.

In particular, breast and prostate cancer screenings have a greater tendency to detect more kinds of cancers that don’t always require treatment.

Colon and cervical cancer screenings, on the other hand, more often lead to early detection of aggressive, harmful types of cancers and have also reduced late-stage forms of the disease. So more frequent screenings and aggressive treatments make more sense.

In order to change the overdiagnosis and overtreatment of cancer, the NCI panel suggests changing the language surrounding certain kinds of slow-growing cancers. The term “cancer” should be reserved only for types of the disease that are lethal if left untreated, it says. Some types shouldn’t be called cancer at all, “so it doesn’t frighten people,” Dr. Esserman says, and instead should be labelled as “indolent lesions of epithelial origin,” or IDLE.

“We’ve seen, in any situation that you screen, that every polyp does not grow to become cancer,” Esserman said. “We don’t call polyps cancer.”

She also recommends that oncologists create patient registries to track data on slow-growing tumors and lesions, and focus on getting new cancer drugs to market for fast-growing tumors.

“People should understand that cancer is not an emergency,” she says. “You have time to learn about it. Doing less can be better.”