Call It Cancer and Do Nothing? Untenable!
Call It Cancer and Do Nothing? Untenable!
Kathy D. Miller, MD: Hi. I'm Dr. Kathy Miller, Associate Professor of Medicine at the Indiana University School of Medicine in Indianapolis. I'm joined today by my colleague, Dr. Maurie Markman. Dr. Markman is the Clinical Professor at the Drexel University College of Medicine, Senior Vice-President for Clinical Affairs, and the National Director for Medical Oncology at the Cancer Treatment Centers of America in Philadelphia.
Earlier this week, the National Cancer Institute published a report in JAMA, "Overdiagnosis and Overtreatment in Cancer: An Opportunity for Improvement," a really thought-provoking report that raises a number of important questions. Maurie, for some of our listeners who might not have seen this report yet, can you summarize the proposal?
Maurie Markman, MD: Kathy, it's a really thought-provoking report. These authors have been involved in these questions before. A focus of the report was on breast cancer and on prostate cancer, but it was also a very general discussion on the question of screening and the possibility that, as a result of screening, conditions are found that are very unlikely, at least statistically, to ever become what we would call cancer.
Of course, the issue is not only that these conditions may not progress, but in fact they may be treated aggressively as cancer. The argument of these authors was that perhaps [treatment] is not necessary. They used some well-known figures showing that even though we've found a number of these so-called early cancers, the incidence of more advanced, late-stage cancers has not really changed. Therefore, the argument is, again, statistically, that many of these lesions that are being treated in fact would never have progressed to a more advanced disease. Their challenge to readers is that maybe we ought to fundamentally change some of the ways that we think of things and do things, and very specifically revise what we call cancer.
Dr. Miller: I think this brings up a lot of tough questions for us. On the other hand, it's hard to talk publicly about the importance of screening and early detection and how detecting cancer earlier gives you a better chance of survival, and then suggest that maybe we went too far with that and some of these lesions shouldn't be diagnosed. Are you worried that this will have people tossing up their hands and not proceeding with screening for things that might be helpful?
Dr. Markman: I'm very worried. Again, I take the authors at their word because they are very fine people, and I don't think they are suggesting anything other than that we need to engage in a conversation about this. But I would be very worried if, for example, their suggestions were simply accepted and [we decided] that we no longer would call them cancer and that we would change the way we do things, because there is some potential for overtreatment, as defined by the authors. We, in fact, could potentially reverse some major advances in [screening in] a number of areas.
Mixed Message for Cancer Screening?
Kathy D. Miller, MD: Hi. I'm Dr. Kathy Miller, Associate Professor of Medicine at the Indiana University School of Medicine in Indianapolis. I'm joined today by my colleague, Dr. Maurie Markman. Dr. Markman is the Clinical Professor at the Drexel University College of Medicine, Senior Vice-President for Clinical Affairs, and the National Director for Medical Oncology at the Cancer Treatment Centers of America in Philadelphia.
Earlier this week, the National Cancer Institute published a report in JAMA, "Overdiagnosis and Overtreatment in Cancer: An Opportunity for Improvement," a really thought-provoking report that raises a number of important questions. Maurie, for some of our listeners who might not have seen this report yet, can you summarize the proposal?
Maurie Markman, MD: Kathy, it's a really thought-provoking report. These authors have been involved in these questions before. A focus of the report was on breast cancer and on prostate cancer, but it was also a very general discussion on the question of screening and the possibility that, as a result of screening, conditions are found that are very unlikely, at least statistically, to ever become what we would call cancer.
Of course, the issue is not only that these conditions may not progress, but in fact they may be treated aggressively as cancer. The argument of these authors was that perhaps [treatment] is not necessary. They used some well-known figures showing that even though we've found a number of these so-called early cancers, the incidence of more advanced, late-stage cancers has not really changed. Therefore, the argument is, again, statistically, that many of these lesions that are being treated in fact would never have progressed to a more advanced disease. Their challenge to readers is that maybe we ought to fundamentally change some of the ways that we think of things and do things, and very specifically revise what we call cancer.
Dr. Miller: I think this brings up a lot of tough questions for us. On the other hand, it's hard to talk publicly about the importance of screening and early detection and how detecting cancer earlier gives you a better chance of survival, and then suggest that maybe we went too far with that and some of these lesions shouldn't be diagnosed. Are you worried that this will have people tossing up their hands and not proceeding with screening for things that might be helpful?
Dr. Markman: I'm very worried. Again, I take the authors at their word because they are very fine people, and I don't think they are suggesting anything other than that we need to engage in a conversation about this. But I would be very worried if, for example, their suggestions were simply accepted and [we decided] that we no longer would call them cancer and that we would change the way we do things, because there is some potential for overtreatment, as defined by the authors. We, in fact, could potentially reverse some major advances in [screening in] a number of areas.