Overdiagnosis in Cancer

Paper on Overdiagnosis in Cancer by H. Gilbert Welch and William C. Black
J. Natl. Cancer Inst. published 22 April 2010, 10.1093/jnci/djq099
J Natl Cancer Inst 2010;102:1–9

Link to Journal

Also Editorial by Esserman and Thompson in the same edition of the journal

Link to Journal


Concerning the overdiagnosis issue in cancer screening. The editorial offered a view of reclassifying some low malignancy potential cancers as a tumor of a different name - eg IDLE tumors (tumors of Low Malignant Potential)
The article summarizes the phenomenon of cancer overdiagnosis—the diagnosis of a "cancer" that would otherwise not go on to cause symptoms or death.

They estimated the magnitude of overdiagnosis from randomized trials: about 25% of mammographically detected breast cancers, 50% of chest x-ray and/or sputum-detected lung cancers, and 60% of prostate-specific antigen–detected prostate cancers.

They call for patients to be adequately informed of the nature and the magnitude of the trade-off involved with early cancer detection.

In the Editorial by Esserman and Thompson, they state that we must accept that population screening and diagnostic scans detect substantial numbers of indolent tumors and benign lesions in addition to potentially lethal disease

What we need now in the field of cancer is the coming together of physicians and scientists of all disciplines to reduce the burden of cancer death AND cancer diagnosis. We must advocate for and demand innovation in diagnosis and management, fueled by science, harnessing modeling, molecular, and immunology tools to address this problem.

If we make the distinction between indolence and aggression a focus of our efforts, we are much more likely to achieve it as a goal. A better understanding of the host environments and/or tumor genetics that lead to aggressive or indolent phenotypes could also hold promise for new approaches to prevention.