Imaging advances may be leading to renal cancer overdiagnoses
Improvements in cancer detection are a welcome change, but some experts are concerned that advances may be leading to more patients being overdiagnosed.
A new paper in International Urology and Nephrology suggests this is the case for renal cell carcinoma (RCC), which has been on the rise in recent decades. RCC diagnoses have increased steadily over the last 30 years, rising by up to 3% annually in the United States alone. The American Cancer Society estimates that about 80,000 people in the U.S. will be diagnosed with RCC this year, and around 15,000 of those cases will be fatal.
Despite the rise in RCC rates, mortality has remained stable. This could be owed to overdiagnosis, triggered largely by advances in modern medical imaging capabilities, suggest study co-authors Katherine Vallecilla Valencia and Herney Andres Garcia-Perdomo, both with the division of Urology/urooncology at the University of the Valley in Cali, Colombia.
“The widespread use of cross-sectional imaging, particularly computed tomography (CT) and magnetic resonance imaging (MRI), has markedly increased the incidental detection of RCCs, with more than 50% now diagnosed incidentally,” the duo noted.
They added that most of the incidental lesions are “benign or biologically indolent.” However, it is often the case that this is not discovered until these lesions are surgically removed. This can create physical, financial and emotional strain for patients, and risks wasting medical resources.
Although the American College of Radiology has evidence-based guidelines on how to manage incidental findings, many providers tend to err on the side of caution when an unexpected lesion presents itself on imaging. This often leads to recommendations for additional scans and follow-ups, but the authors contend that this conservative strategy can put patients through unnecessary exams and procedures at their own expense.
“While early detection may benefit patients with aggressive disease, it can also lead to overtreatment, psychological burden, and increased healthcare costs,” the authors cautioned.
The authors signaled support for alternative strategies such as active surveillance, artificial intelligence-based risk stratification and the inclusion of radiomics in imaging assessments to help reduce the amount of unnecessary and costly procedures patients endure.
The paper is available here behind a paywall.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.