Laurence Klotz1. 1. Division of Urology, University of Toronto, Toranto, Ontario, Canada. Laurence.klotz@sunnybrook.ca
Abstract
PURPOSE OF REVIEW: Overdiagnosis has become a major problem in medicine in general and cancer in particular. This is a summary of this problem. RECENT FINDINGS: Because of earlier detection, the nature of cancer has changed, from a disease usually diagnosed at a late and incurable stage to a heterogeneous condition that varies from clinically insignificant to rapidly aggressive. Screening programs for cancer have resulted in a dramatic increase in the diagnosis of clinically insignificant disease, balanced by improved survival and mortality because of significant cancers being diagnosed at a more curable stage. Overdiagnosis requires the presence of microfocal disease and a screening test to identify this. This exists for breast, prostate, and thyroid cancers, and to a lesser degree for renal and lung cancer. The problem of cancer overdiagnosis and overtreatment is complex, with numerous causes and many trade-offs. It is particularly important in prostate cancer, but is a major issue in many other cancer sites. Screening for prostate cancer appears, based on the best data from randomized trials, to significantly reduce cancer mortality. SUMMARY: Reducing overtreatment in patients diagnosed with indolent disease is critical to the success of screening.
PURPOSE OF REVIEW: Overdiagnosis has become a major problem in medicine in general and cancer in particular. This is a summary of this problem. RECENT FINDINGS: Because of earlier detection, the nature of cancer has changed, from a disease usually diagnosed at a late and incurable stage to a heterogeneous condition that varies from clinically insignificant to rapidly aggressive. Screening programs for cancer have resulted in a dramatic increase in the diagnosis of clinically insignificant disease, balanced by improved survival and mortality because of significant cancers being diagnosed at a more curable stage. Overdiagnosis requires the presence of microfocal disease and a screening test to identify this. This exists for breast, prostate, and thyroid cancers, and to a lesser degree for renal and lung cancer. The problem of cancer overdiagnosis and overtreatment is complex, with numerous causes and many trade-offs. It is particularly important in prostate cancer, but is a major issue in many other cancer sites. Screening for prostate cancer appears, based on the best data from randomized trials, to significantly reduce cancer mortality. SUMMARY: Reducing overtreatment in patients diagnosed with indolent disease is critical to the success of screening.
Authors: Michael S Manak; Jonathan S Varsanik; Brad J Hogan; Matt J Whitfield; Wendell R Su; Nikhil Joshi; Nicolai Steinke; Andrew Min; Delaney Berger; Robert J Saphirstein; Gauri Dixit; Thiagarajan Meyyappan; Hui-May Chu; Kevin B Knopf; David M Albala; Grannum R Sant; Ashok C Chander Journal: Nat Biomed Eng Date: 2018-09-17 Impact factor: 25.671
Authors: Dimo Dietrich; Oliver Hasinger; Lionel L Bañez; Leon Sun; Geert J van Leenders; Thomas M Wheeler; Chris H Bangma; Nicolas Wernert; Sven Perner; Stephen J Freedland; John M Corman; Michael M Ittmann; Amy L Lark; John F Madden; Arndt Hartmann; Philipp Schatz; Glen Kristiansen Journal: J Mol Diagn Date: 2012-12-22 Impact factor: 5.568