Some in the health care community are now worried that better cancer screening and awareness is causing over-diagnosing of the disease, and they feel that the term “cancer” should be narrowed down. Some forms of cancer actually are unlikely to cause harm, and may not need to be aggressively treated, if they need to be treated at all, and cancer experts in the US feel that these forms should be eliminated from the category all together.
A working group of the US National Cancer published a commentary online in the Journal of the American Medical Association that supports these theories. According to the commentary, the term “cancer” often causes the idea that there is something life threatening that is going on. Dr. Laura Esserman, who is the director of Carol Franc Buck Breast Care Center with the University of California, San Francisco and co-authors feel that the term “cancer” should be saved to describe lesions that have a reasonable chance of becoming life threatening when left untreated.
Esserman, as well as her co-authors, have given the example of a “premalignant” condition that is called ducta carcinoma in Situ. By finding and eliminating these lesions, it is thought that cancer could be avoided; when, in fact, this measure has not been successful in lowering the incidences of invasive cancer.
According to the authors, it is now necessary to recognize that the more that cancer screening takes place, the more it is likely that over-diagnosis of cancer will occur. Overdiagnosis is more common after tumors are detected which could be left untreated without harm during the lifetime of the patient.
Some cancers are “indolent” and would cause no harm during the lifetime of patients; most common are lung, thyroid, prostate and breast cancer.
How often people should be screened for cancer will depend largely on the growth rate of cancer. For tumors that are indolent, it can be more harmful to detect them because it can often cause people to be over-treated. However, not screening can be damaging when it comes to the progressive, slow growing pre-cancerous lesions that include polyps associated with colon cancer and lesions associated with cervical cancer.
The authors feel that with a few steps, such as creating what they call “observational registries,” that would generate tumor data regarding growth rates; patients could have the option to choose less invasive treatments with confidence.
The commentary suggests that while no physician wants to over-diagnose or over-treat cancer, an increase in patient awareness and screening have been effective at increasing the chances identifying many different cancers, some of them that are not even potentially fatal.