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The Problem of Cancer Overdiagnosis and Overtreatment

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Active Surveillance for Localized Prostate Cancer

Part of the book series: Current Clinical Urology ((CCU))

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Abstract

Due to earlier detection, the nature of cancer has changed, from a disease usually diagnosed at a late and incurable stage to a heterogeneous condition that varies from clinically insignificant to rapidly aggressive. Screening programs for cancer have resulted in a dramatic increase in diagnosis of clinically insignificant disease, balanced by improved survival and mortality due to significant cancers being diagnosed at a more curable stage. Overdiagnosis requires the presence of microfocal disease and a screening test to identify this. This exists for breast, prostate, and thyroid cancers, and to a lesser degree for renal and lung cancer. The problem of cancer overdiagnosis and overtreatment is complex, with numerous causes and many trade-offs. It is particularly important in prostate cancer but is a major issue in many other cancer sites. Screening for prostate cancer appears, based on the best data from randomized trials, to significantly reduce cancer mortality. However, reducing overtreatment in patients diagnosed with indolent disease is critical to the success of screening.

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References

  1. Dorland WAN. Dorland’s illustrated medical dictionary. 28th ed. Philadelphia: W.B. Saunders Company; 1994.

    Google Scholar 

  2. Dorland’s Online Dictionary. http://www.dorlands.com/wsearch.jsp. Accessed 19 July 2011.

  3. Feinstein AR. Symptoms as an index of biological behaviour and prognosis in human cancer. Nature. 1966 Jan 15;209(5020):241–5.

    Article  PubMed  CAS  Google Scholar 

  4. Mooi WJ, Peeper DS. Oncogene-induced cell senescence—halting on the road to cancer. N Engl J Med. 2006;355(10):1037–46.

    Article  PubMed  CAS  Google Scholar 

  5. Folkman J, Kalluri R. Cancer without disease. Nature. 2004;427(6977):787.

    Article  PubMed  CAS  Google Scholar 

  6. Serrano M. Cancer regression by senescence. New Engl J Med. 2007;356(19):1996–7.

    Article  PubMed  CAS  Google Scholar 

  7. Sakr WA, Grignon DJ, Haas GP, Heilbrun LK, Pontes JE, Crissman JD. Age and racial distribution of prostatic intraepithelial neoplasia. Eur Urol. 1996;30(2):138–44.

    PubMed  CAS  Google Scholar 

  8. Stamatiou K, Alevizos A, Agapitos E, Sofras F. Incidence of impalpable carcinoma of the prostate and of non-malignant and precarcinomatous lesions in Greek male population: an autopsy study. Prostate. 2006;66(12):1319–28.

    Article  PubMed  Google Scholar 

  9. Damiano R, Lorenzo GD, Cantiello F, et al. Clinicopathologic features of prostate adenocarcinoma incidentally discovered at the time of radical cystectomy: an evidence-based analysis. Eur Urol. 2007;52(3):648–57.

    Article  PubMed  Google Scholar 

  10. Harach HR, Franssila KO, Wasenius V. Occult papillary carcinoma of the thyroid: a “normal” finding in Finland. A systematic autopsy study. Cancer. 1985;56(3):531–8.

    Article  PubMed  CAS  Google Scholar 

  11. Welch HG, Black WC. Using autopsy series to estimate the disease “reservoir” for ductal carcinoma in situ of the breast: how much more breast cancer can we find? Ann Intern Med. 1997;127(11):1023–8.

    PubMed  CAS  Google Scholar 

  12. Welch G, Black WC. Overdiagnosis in Cancer. JNCI. 2010;102:605–13.

    Article  PubMed  Google Scholar 

  13. Ries LAG, Melbert D, Krapcho M, et al. SEER cancer statistics review, 1975–2005. Bethesda (MD): National Cancer Institute. Based on November 2007 SEER data submission, posted to the SEER Web site. http://seer.cancer.gov/csr/1975_2005/ (2008). Accessed 18 Aug 2009.

  14. Merrill RM, Feuer EJ, Warren JL, Schussler N, Stephenson RA. Role of transurethral resection of the prostate in population-based prostate cancer incidence rates. Am J Epidemiol. 1999;150(8):848–60.

    Article  PubMed  CAS  Google Scholar 

  15. Zackrisson S, Andersson I, Janzon L, Manjer J, Garne JP. Rate of over-diagnosis of breast cancer 15 years after end of Malmö mammographic screening trial: follow-up study. BMJ. 2006;332(7543):689–92.

    Article  PubMed  Google Scholar 

  16. Welch HG, Schwartz LM, Woloshin S. Ramifications of screening for breast cancer 1 in 4 cancers detected by mammography are pseudocancers. BMJ. 2006;332:727.

    Article  PubMed  Google Scholar 

  17. Jemal A, et al. Ca statistics 2010. CA Cancer J Clin. 2010;60:277–300.

    Article  PubMed  Google Scholar 

  18. Andriole GL, Grubb RL, Buys SS, et al. For the PLCO Project Team. Mortality results from a randomized prostate-cancer screening trial. N Engl J Med. 2009;360(13):1310–9.

    Google Scholar 

  19. Schroder FH, Hugosson J, Roobol MJ, et al. For the ERSPC Investigators. Screening and prostate-cancer mortality in a randomized European study. N Engl J Med. 2009;360(13):1320–8.

    Google Scholar 

  20. Draisma G, Boer R, Otto SJ, et al. Lead times and overdetection due to prostate-specific antigen screening: estimates from the European Randomized Study of Screening for Prostate Cancer. J Natl Cancer Inst. 2003;95(12):868–78.

    Article  PubMed  Google Scholar 

  21. Bessho F. Where should neuroblastoma mass screening go? Lancet. 1996;348(9043):1672.

    Article  PubMed  CAS  Google Scholar 

  22. Pohl H, Welch HG. The role of overdiagnosis and reclassification in the marked increase of esophageal adenocarcinoma incidence. J Natl Cancer Inst. 2005;97(2):142–6.

    Article  PubMed  Google Scholar 

  23. Davies L, Welch HG. The increasing incidence of thyroid cancer in the United States, 1973–2002. JAMA. 2006;295(18):2164–7.

    Article  PubMed  CAS  Google Scholar 

  24. Dennis LK. Analysis of the melanoma epidemic, both apparent and real: data from the 1973 through 1994 surveillance, epidemiology, and end results program registry. Arch Dermatol. 1999;135(3):275–80.

    Article  PubMed  CAS  Google Scholar 

  25. Crispen PL, Viterbo R, Boorjian SA, Greenberg RE, Chen DY, Uzzo RG. Natural history, growth kinetics, and outcomes of untreated clinically localized renal tumors under active surveillance. Cancer. 2009 Jul 1;115(13):2844–52.

    Article  PubMed  Google Scholar 

  26. Volpe A, Jewett MA. The natural history of small renal masses. Nat Clin Pract Urol. 2005 Aug;2(8):384–90.

    Article  PubMed  Google Scholar 

  27. Zhang J, Kang SK, Wang L, Touijer A, Hricak H. Distribution of renal tumor growth rates determined by using serial volumetric CT measurements. Radiology. 2009;250(1):137–44.

    Article  PubMed  Google Scholar 

  28. Hugosson J, Carlsson S, Aus G, Bergdahl S, Khatami A, Lodding P, Pihl CG, Stranne J, Holmberg E, Lilja H. Mortality results from the Göteborg randomised population-based prostate-cancer screening trial. Lancet Oncol. 2010 Aug;11(8):725–32.

    Article  PubMed  Google Scholar 

  29. Raffle AE, Muir Gray JA. Screening: evidence and practice. New York: Oxford University Press; 2007. p. 68.

    Book  Google Scholar 

  30. Nadler RB, Loeb S, Roehl KA, Antenor JA, Eggener S, Catalona WJ. Use of 2.6 ng/ml prostate specific antigen prompt for biopsy in men older than 60 years. J Urol. 2005 Dec;174(6):2154–7.

    Article  PubMed  Google Scholar 

  31. MacMahon H, Austin JH, Gamsu G, et al. Guidelines for management of small pulmonary nodules detected on CT scans: a statement from the Fleischner Society. Radiology. 2005;237(2):395–400.

    Article  PubMed  Google Scholar 

  32. Song JH, Chaudhry FS, Mayo-Smith WW. The incidental adrenal mass on CT: prevalence of adrenal disease in 1,049 consecutive adrenal masses in patients with no known malignancy. Am J Roentgenol. 2008;190(5):1163–8.

    Article  Google Scholar 

  33. International Early Lung Cancer Early Action Program Investigators. Survival of patients with stage I lung cancer detected on CT screening. N Engl J Med. 2006;355(17):1763–71.

    Article  Google Scholar 

  34. Campbell PA, Conrad RJ, Campbell CM, Nicol DL, MacTaggart P. Papillary urothelial neoplasm of low malignant potential: reliability of diagnosis and outcome. BJU Int. 2004 Jun;93(9):1228–31.

    Article  PubMed  CAS  Google Scholar 

  35. Jones TD, Cheng L. Papillary urothelial neoplasm of low malignant potential: evolving terminology and concepts. J Urol. 2006 Jun;175(6):1995–2003.

    Article  PubMed  Google Scholar 

  36. Esserman L, Shieh Y, Thompson I. Rethinking screening for breast cancer and prostate cancer. JAMA. 2009;302:1685–92.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada

    Laurence Klotz M.D., F.R.C.S.C.

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  1. Laurence Klotz M.D., F.R.C.S.C.
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Correspondence to Laurence Klotz M.D., F.R.C.S.C. .

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Editors and Affiliations

  1. University of Toronto, Sunnybrook Health Sciences Centre, Division of Urology, Toronto, M4N 3M5, Ontario, Canada

    Laurence Klotz

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Klotz, L. (2012). The Problem of Cancer Overdiagnosis and Overtreatment. In: Klotz, L. (eds) Active Surveillance for Localized Prostate Cancer. Current Clinical Urology. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-61779-912-9_1

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  • DOI: https://doi.org/10.1007/978-1-61779-912-9_1

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  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-61779-911-2

  • Online ISBN: 978-1-61779-912-9

  • eBook Packages: MedicineMedicine (R0)

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