Low-risk growths in the breast, prostate and elsewhere should no longer be named cancer and screening efforts to spot them should be cut back, a panel convened by the U.S. National Cancer Institute said.
A three decadelong emphasis on the early identification of tumors was based on the idea that cancerous cells always spread and eventually kill, the researchers wrote 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 personalize 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 center. "By recognizing that cancer is not one disease, but a number of different diseases, we can individualize our treatment."
Lung cancer is a disease that merits screening for high- risk patients, a separate panel of doctors said. Smokers ages 55 and older should get imaging scans each year to detect lung cancer when it is small and can be treated, according to new recommendations from the U.S. Preventive Services Task Force. Such testing may save 20,000 lives a year, the panel said.
The group led by Esserman said that doctors and patients need to realize 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 their recommendations, the authors of yesterday's medical journal editorial called for an independent, broad group under the auspice of an organization such as the Institute of Medicine of the National Academies to review and rename less- risky lesions and growths currently identified as cancer.