Low-risk growths in the breast, prostate and elsewhere should no longer be called cancer and screening efforts to spot them should be cut back, a working group from the US National Cancer Institute has said.
A three decade-long emphasis on the early identification of tumors was based on the idea that cancerous cells always spread and eventually kill, the researchers have written in the Journal of the American Medical Association.
Instead of sparking a drop in cancer deaths, the approach has led to the detection and toxic treatment of millions of people who may have never had any symptoms from indolent lesions.
"The goal going forward is to personalise screening strategies, and focus screening policies on the conditions that are most likely to result in aggressive illness and death," said Laura Esserman, director of breast care at the University of California, San Francisco's cancer centre.
“By recognising that cancer is not one disease, but a number of different diseases, we can individualise our treatment.”
Lung cancer is a disease that merits screening for high-risk patients, a separate panel of doctors said yesterday.
Smokers ages 55 and older should get CT scans each year to detect lung cancer when it is small and can be treated, according to new recommendations from the US Preventive Services Task Force. Annual testing could save 20,000 lives a year, the panel said.
The group led by Dr Esserman said that doctors and patients need to realise that over-diagnosis and excess treatment is common, and screening exacerbates the problem.
Steps should be taken to reduce the risk, such as cutting the frequency of screening and its use in people who probably won’t get the disease, they said. The bar also should be raised for repeat tests and biopsies, they said.
“Although no physician has the intention to over-treat or over-diagnose cancer, screening and patient awareness have increased the chance of identifying a spectrum of cancers, some of which are not life threatening,” the researchers said. “An ideal screening intervention focuses on detection of disease that will ultimately cause harm, that is more likely to be cured if detected early and for which curative treatments are more effective in early-stage disease.”
Among the researchers’ recommendations, are that an independent, broad group review and rename less- risky lesions and growths currently identified as cancer. - Bloomberg