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Dr. Simeon Margolis
Reducing Risk and Living with Cancer

Living with Screening Tests & the Diagnosis of “Cancer”
by Simeon Margolis

Screening testScreening tests are a valuable asset in detecting and treating early stages of cancer in order to prevent later symptoms or death. But it’s unfortunate that we are all conditioned to associate the word “cancer” with certain, impending death—because that’s not the case with many cancers. Still, anxiety and fear are understandable when told that the results of a screening test indicate the possibility of cancer. However, it is critical to understand the flip side of this issue—that such tests can often lead to overdiagnosis of many forms of cancer.

An overdiagnosis of cancer?

The term overdiagnosis is used when a condition is diagnosed that would otherwise not go on to cause symptoms or death. There are two possible explanations for cancer overdiagnosis:

  • The cancer never progresses or even gets smaller
  • The cancer progresses so slowly that a patient dies of other causes before the cancer causes symptoms.

Overdiagnosis is especially common with certain cancers, as described below. Unfortunately, it is presently not possible to determine which of the detected cancers are likely to go on to produce symptoms and death. Consequently, doctors and patients alike often want to cut them out. Much needed by patients is a meeting with their physician to thoroughly discuss most likely outcomes of active treatment versus observation.

OOn the other hand, experience has shown that early detection and prompt removal of precancerous colon and cervical cancers found by screening programs have reduced the development of late-stage disease. This is another reason why doctors are more likely to opt for immediate treatment.

Recommendations on the problem of overdiagnosis

Some of the recommendations for the medical community and the general public come from a meeting convened by the National Cancer Institute in March 2012:

  • Raise awareness of the issue. “Physicians, patients, and the general public must recognize that overdiagnosis is common and occurs more frequently with cancer screening. Overdiagnosis, or identification of indolent cancer, is common in breast, lung, prostate, and thyroid cancer.”
  • Change cancer terminology. The term “cancer” should only be used to describe lesions with a “reasonable likelihood of lethal progression if left untreated”.
  • Lessen overdiagnosis. This can be done by appropriately reducing low-yield diagnostic evaluations, decreasing the frequency of screening examinations, “focusing screening on high-risk populations, raising thresholds for recall and biopsy, and testing the safety and efficacy of risk-based screening approaches to improve selection of patients for cancer screening. The ultimate goal is to preferentially detect consequential cancer while avoiding detection of inconsequential disease.”

What can or should you do?

Our medical community will continue to refine its understanding, progression, and treatment of different types of cancer. In the meantime, the most important thing that you can do as a patient is to discuss with your doctor the likelihood of progression. Then decide together if you should opt for observation rather than treatment.

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