The growing case for doing less: How harmless cancers are being overdiagnosed in America
Key Excerpts from Article on Website of Fortune
Posted: November 7th, 2023
In 2009, Laura Esserman, a breast cancer surgeon and oncology specialist in San Francisco, co-published an article in the Journal of the American Medical Association (JAMA) suggesting that it was time to rethink routine screening for breast and prostate cancer. The current approach, she wrote, wasn’t reducing aggressive or late-stage disease as much as had been hoped. Instead, it was leading to overdiagnosis. Ductal carcinoma in situ, a condition sometimes called non-invasive or stage-zero breast cancer, is a very early finding of disease in the cells that line the milk ducts of the breast. For decades, the diagnosis of DCIS has routinely led to surgery–a mastectomy or a lumpectomy (a partial breast resection) that’s often combined with radiation treatment. The issue? In a study of 100,000 women who were followed for two decades, patients who’d been diagnosed with and treated for DCIS ultimately had about the same chance of dying from breast cancer as those in the general population. In August, a meta-analysis of 18 randomized clinical trials involving 2.1 million people, published in JAMA Internal Medicine, concluded that “current evidence does not substantiate the claim” that common cancer screens (mammography, colonoscopy, prostate-specific antigen (PSA) testing, etc) save lives. “In our exuberance to find these cancers, we have basically turned a lot of healthy people who are not destined to die from the cancers into patients,” says Ade Adamson, a cancer screening expert.
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