Expect Questions About Screening and Potential Overdiagnosis


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Science, genomics, is going to move us toward being able to identify the cancer that needs treatment vs the cancer that doesn’t need treatment, in the very near future.
— Otis W. Brawley, MD, FACP

“The big thing that is going to become more and more of an issue, and that you are going to hear a lot more of this year, and in the next several years, is overdiagnosis,” Otis W. Brawley, MD, FACP, Chief Medical Officer of the American Cancer Society, told The ASCO Post in an interview following the release of the latest cancer statistics.1 “I worry that there has been too much emphasis on screening, even though I am still trying to have my cake and eat it, too, and say that screening can be beneficial.”

“We’ve got overdiagnosis in kidney cancer, overdiagnosis in bladder cancer, even lung cancer. There are estimates of 10% to 15% of screen-diagnosed lung cancers are overdiagnosis,” Dr. Brawley added.

There are “now 12 studies to show that overdiagnosis exists in breast cancer,” he reported. In the United States the rate is “between 15% and 25%.” An editorial that Dr. Brawley wrote on accepting the existence of breast cancer overdiagnosis recently appeared in the Annals of Internal Medicine.2

Follow Current Guidelines

Overdiagnosis should be acknowledged, he advised, “but we’ve got studies to show that by treating all the women we find with screen-detected disease, we save some lives that need to be saved. And science, genomics, is going to move us toward being able to identify the cancer that needs treatment vs the cancer that doesn’t need treatment, in the very near future.”

In the meantime, women should “absolutely” continue to follow the current screening guidelines, he advised. “One of my great nightmares is that there are women out there who are reading about overdiagnosis and deciding, this is a reason why I don’t need to get treated for my diagnosed breast cancer.” ■

Disclosure: Dr. Brawley reported no potential conflicts of interest.

References

1. Siegel RL, Miller KD, Jemal A: Cancer statistics, 2017. CA Cancer J Clin 67:7-30, 2017.

2. Brawley OW: Accepting the existence of breast cancer overdiagnosis. Ann Intern Med. January 10, 2017 (early release online).


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Screening and early detection activities, while important, have been overemphasized at the expense of tobacco cessation, healthy eating, and active living.
— Otis W. Brawley, MD, FACP

Many news reports about the latest cancer statistics released by the American Cancer...


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