Early detection : cancer that is not cancer

Not every suspicion of a tumor means danger. American medical experts warn against too frequent diagnoses and unnecessary treatments.

With X-ray vision. Early breast cancer detection depends on experience and accuracy to distinguish harmless from questionable changes. Photo: p-a/dpa

Cancer is no longer taboo. The disease, its timely detection and prevention are the focus of public attention. Nevertheless, the success leaves much to be desired, American physicians complain. Early detection, in particular, has led to more diagnoses of early stages of cancer, they say, but. Nevertheless, dangerous advanced cancers occur just as often as before. The condition is detected and treated too often, writes a U.S. National Cancer Institute task force in the online edition of the journal Jama – and makes suggestions to improve the situation. Among them, the one to erase from some diagnoses the name "cancer.

Cancer is considered a potentially fatal disease. If not treated, it kills the sufferer, it is believed. But it is far from always that simple. Malignant tumors typically grow unchecked and destructively and form metastases in other organs. The transition from a healthy cell to a diseased one often occurs gradually and over a long period of time. It can also falter and eventually stop.

Superfluous tumor therapies can have serious side effects

Distinguishing "benign" from "malignant" can accordingly be very difficult in practice. Nevertheless, the label "cancer" triggers panic in the patient and pressure for action in the physician. The result can be superfluous treatment of early tumor stages with sometimes serious side effects.

Laura Esserman of the University of California in San Francisco and her colleagues distinguish three groups of cancers on which early detection programs and methods had different effects. The first group includes breast and prostate cancer. Early detection (screening) has led to a significant increase in the number of cases, calculated per 100,000 inhabitants. In contrast, the risk of dying from these diseases has decreased significantly. Screening results in "indolent" or "dormant" tumors being found and treated unnecessarily – hence the increase in incidence – but also contributes in part to fewer people dying from the cancer, recognizable by the lower risk of mortality. A mixed picture, then.

True screening for colorectal and cervical cancer

Things look best in the second group. These are tumors that have become rarer as a result of early detection, and which are also less likely to die from. Examples include colorectal and cervical cancers, where one can speak of true screening rather than just early detection. Things look less good in the third group – rare forms of cancer, where supposed early detection has led to a significant increase in diagnoses without having a significant impact on the incidence of rare but aggressive tumors. Examples of the scientists are thyroid cancer and black skin cancer (melanoma).

"We need a definition of cancer for the 21st century. Century instead of the 19th century. "We’re not using the 21st-century methods that we’re using," Otis Brawley, medical director of the American Cancer Society, told The New York Times. Breast and prostate cancers, he said, are the best examples to frame the problem. "Based on data, one-third of women have localized (narrow) forms of breast cancer that look like cancer but will never kill these women," Brawley told The Washington Post. Many women are unnecessarily irradiated or have their breasts removed. "We ‘cure’ these women with their localized tumors, in the process they don’t need to be cured at all."

Avoiding panic through new designations

To counter panic, scientists suggest reserving the word cancer for those foci of disease that are significantly likely to lead to death if left untreated. Pre-cancerous lesions, on the other hand, should not be called cancer. One example is "ductal carcinoma in situ," a pathological growth in the milk ducts of the mammary gland. "Ductal carcinoma in situ is not cancer, so why do we call it cancer?" says study author Laura Esserman.

"One can understand this criticism," says Rudolf Kaaks of the German Cancer Research Center in Heidelberg. "In practice, however, the problem is drawing the line between ‘aggressive’ and ‘non-aggressive’."It is a matter of understanding which supposedly harmless growths can become dangerous. The members of the cancer researchers’ working group don’t see it any differently. They also advocate developing better tests for low-risk changes and monitoring patients with such changes.

By no means do they want to deny the advances in early detection, the doctors write. The crucial goal is to detect serious cancers and to ignore trivial disorders. The researchers see their recommendations as food for thought, doctors and patients should now discuss openly.

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