NCI Working Group Recommends Changes to Screenings, Treatments, and the Definition of Cancer
A growing concern that hundreds of thousands of men and women are undergoing unnecessary and sometimes harmful treatments for premalignant and slow-growing, low-risk cancerous lesions that may never cause harm has led scientists from a working group of the National Cancer Institute to recommend a strategy to improve the current approach to cancer screening and prevention. The recommendations also call for eliminating the word “cancer” from some common premalignant conditions.
In the article, which appeared in the Journal of the American Medical Association (JAMA), Laura J. Esserman, MD, and colleagues called for physicians, patients, and the general public to recognize and acknowledge that overdiagnosis, or identification of indolent cancer, is common in breast, lung, prostate, and thyroid cancers.
In addition, the authors recommended that the term “cancer” be reserved for describing lesions that have a reasonable likelihood of lethal progression if left untreated. “Premalignant conditions (eg, ductal carcinoma in situ or high-grade prostatic intraepithelial neoplasia) should not be labeled as cancers or neoplasia, nor should the word ‘cancer’ be used in the name,” wrote the scientists. Such conditions should instead be reclassified as IDLE (indolent lesions of epithelial origin).
Other recommendations include:
- A multidisciplinary effort to create reclassification criteria for IDLE conditions.
- Research to identify both benign and slow-growing tumors and aggressive diseases, including the creation of observational registries to learn more about lesions that appear unlikely to turn cancerous. Such registries, said the scientists, would provide data linking disease dynamics and diagnostics needed to provide patients and physicians with the confidence to choose less invasive treatments.
- Mitigating overdiagnosis of indolent disease by reducing frequency of screening examinations, focusing screening on high-risk populations, raising thresholds for patient recall and biopsy, and testing the safety and efficacy of risk-based screening approaches to improve selection of patients for cancer screening.
- Expanding the concept of how to approach cancer progression. Future research should include controlling the environment in which precancerous and cancerous conditions arise, as an alternative to surgical excision, wrote the scientists.
Policies Are Needed to Prevent Overdiagnosis and Overtreatment
Although the original intent of screening was to detect cancer at its earliest stages to improve outcomes, early diagnosis has not led to a proportional decline in later-stage disease or death. “Although no physician has the intention to overtreat or overdiagnose cancer, screening and patient awareness have increased the chance of identifying a spectrum of cancers, some of which are not life threatening. Policies that prevent or reduce the chance of overdiagnosis and avoid overtreatment are needed, while maintaining those gains by which early detection is a major contributor to decreasing mortality and locally advanced disease,” concluded the report.
Ian M. Thompson, Jr, MD, reported serving as a board member or consultant for, and receiving grants or grants pending, payment for lectures, patents, and honoraria from a variety of sources. No other authors reported disclosures.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
