Major Changes Urged for Cancer Screening and Treatment

UCSF News reports on the recommendations of an NCI scientific panel chaired by Laura Esserman, MD, MBA, Professor of Surgery and Radiology and Director, UCSF Carol Franc Buck Breast Care Center,  to reduce overdiagnosis and overtreatment.

To address the growing problem of people being overdiagnosed and overtreated for cancer, a group of scientists convened by the National Cancer Institute and chaired by a UC San Francisco breast cancer expert is proposing a major update of the way the nation approaches diseases now classified as “cancer.”

The “Viewpoint” article was published online on July 29 in the Journal of the American Medical Association.  

When cancer screening programs were widely initiated three decades ago, medical knowledge of the disease was more simplistic. The intent was to detect cancer at its earliest stages to reduce illness and mortality, but in fact early diagnosis has not led to a proportional decline in serious disease and death, the scientists write in the JAMA commentary.

Instead, screening programs are identifying not only malignant cancers, but also slow-growing, low-risk lesions, and sweeping them into the same treatment process. As a result, patients are being diagnosed and treated for forms of cancer that might never actually harm them – a phenomenon that’s been termed overdiagnosis, which translates to “too much medicine.”

Now, with the advancement of scientific understanding of the biology of cancer, the authors say it is time for significant changes in practice and policy.

“By recognizing that cancer is not one disease, but a number of different diseases, we can individualize our treatment based on biology and avoid overtreatment,” said panel chair Laura J. Esserman, MD, MBA, director of the Carol Franc Buck Breast Care Center at the UCSF Helen Diller Family Comprehensive Cancer Center.