Cancer overdiagnosis gets scrutiny as policymakers seek to tame healthcare costs

As the second annual Preventing Overdiagnosis conference gets underway at the University of Oxford, United Kingdom, the Wall Street Journal suggests that it’s time to rethink early cancer detection.

“We’re not finding enough of the really lethal cancers, and we’re finding too many of the slow-moving ones that probably don’t need to be found,” Laura Esserman, MD, a breast-cancer surgeon at the University of California, San Francisco, told the WSJ. Esserman is chair of a National Cancer Institute advisory panel that called in May for renaming low-risk lesions IDLEs, for indolent lesions of epithelial origin.

With the cost of cancer care exceeding $100 billion annually in the U.S., the author notes that the issue of overdiagnosis is already impacting treatment of prostate cancer. Experts believe more than 60% of prostate cancers pose little threat, and 15% of patients now opt to monitor rather than treat, a trend likely to have implications for radiology.

Overdiagnosis is an issue of debate for other cancers as well, with ductal carcinoma in-situ an example of a cancer that has been hotly debated within the specialty of radiology. "There's no question that periodic screening doesn't catch fast-growing cancers, but you save lives by finding moderate and slow-growing cancers and finding them earlier," Daniel Kopans, MD, Massachusetts General Hospital, told the WSJ.

The subject of overdiagnosis is rife with ethical issues, as well. “I am confident that somewhere between 10% and 30% of women with localized invasive breast cancer would be just fine if we just watched them,” the WSJ quoted Otis Brawley, MD, chief medical officer, American Cancer Society. “But I cannot look into a patient’s eyes and say, ‘You’re one of the 10% to 30% that should not be treated.”

The WSJ shares the following estimates of individual cancer overdiagnosis, based on various sources:

• Prostate: 60%

• Breast: 30%

• Thyroid: 90%

• Skin: 90%

• Lung: 18%

Esserman is launching a study to test a new approach to breast-cancer screening, the WSJ reports. She will seek to enroll 100,000 patients from the five system  as well as medical centers in Stanford and North Dakota. Patients with average risk will have biannual studies, and higher risk patients will be screened more often using a variety of imaging modalities.

The Preventing Overdiagnosis conference is cosponsored by The Dartmouth Institute, the journal BMJ, Bond University, Consumer Reports, and the Oxford University’s Centre for Evidence Based Medicine, is in its second year.